Cross-Border Family Therapy: An Innovative Approach to Working with Latina Refugee Women in Therapy

In the era of transnationalism, family therapists working with immigrant women are provided with the space to be innovative in their search for alternatives to Eurocentric approaches. Doing so can help therapists to best serve working-class immigrants and refugees who arrive in North America to escape violence and poverty. The case presented in this article highlights the cross-border interconnectedness between a Salvadoran refugee woman in Canada and other people in her life. The woman's sources of resilience were her emotional and spiritual connections with her extended family and community members who lived in her country of origin and in the United States. Implications for practice are presented last.     

Experiential Family Therapy: An Innovative Approach to the Resolution of Family Conflict in Genetic Counseling

Experiential family therapy is an intuitive approach that utilizes active, multisensory techniques. These techniques, such as role plays and drawings, increase the family's expression of affect and uncover new information. Increased affect and uncovered information stimulate change and growth in the family system. Experiential techniques are especially useful when more traditional, verbal-based communication is not effective. In this article, I will present a pediatric case in which the patient, a 7-year-old boy diagnosed with autism, was referred to the genetics clinic to rule out the presence of an associated genetic disorder. I will then describe a hypothetical second counseling session with the same family and suggest how three experiential family therapy techniques: family drawing, empty chair technique, and continuums might be used in the session to help resolve a marital conflict between the patient's parents.     

An Innovative Treatment Approach for Children With Anxiety Disorders and Medically Unexplained Somatic Complaints

Anxiety disorders in children and adolescents are largely undetected and the majority of youth do not receive services. Given the deleterious consequences of anxiety disorders, early identification and intervention have public health implications. In order to increase identification and treatment of anxious youth, expansion to nonpsychiatric settings (i.e., pediatric medical settings, schools) is necessary. Pediatric medical offices represent ideal settings for detection and intervention for several reasons: (1) access to large numbers of children, (2) high prevalence of unrecognized anxiety disorders in medical settings, and (3) an association between anxiety disorders and medically unexplained somatic symptoms. This paper describes a cognitive-behavioral intervention for youth who present to pediatric medical settings with nonmedical somatic symptoms and undiagnosed anxiety disorders. We explain the rationale for and focus of our treatment approach, present two case studies illustrating the treatment process, and conclude with a discussion of implementation considerations.     

Interpersonal Perceptions and Metaperceptions in Dialogic Action Therapy: A Relational Methodological Approach to Theory Construction

Abstract

Two forms of understanding in theories of therapy are identified: empathic understanding rooted in individualism, and reality-based understanding that acknowledges the relational character of human existence. We argue for regarding these two forms of understanding as complementary. This requires a paradigmatic shift from methodological individualism to methodological relationalism, which asserts that the analysis of role relationships precedes that of individuals and situations. Informed by methodological relationalism, dialogic action therapy accords prominence to the creation of a therapeutic relationship between therapist and client, between whom bidirectionality of perceptions is inherent. We develop a formal analytic scheme for theory building. Six major constructs, degrees of perception, directionality, agreement, reciprocity, accuracy, and congruence, are employed to facilitate the analysis of therapist and client perceptions and metaperceptions of trust in depth. The implications for therapy and methodology of measurement are discussed.     

Relational Individualism and Feminist Therapy

My aim here is to clarify the practice of honoring and validating the relational model of self which plays an important role in feminist therapy. This practice rests on a tangle of psychological claims, moral and political values, and mental health norms which require analysis. Also, severe pathology affects the relative “relationality” of the self. By understanding it we can better understand the senses of autonomy compatible with and even required for a desired relationality.     

Externalizing Metaphors Therapy and Innovative Moments: A Four-Session Treatment Group for Anxiety

The zeitgeist for brief services psychotherapy efficacy is well underway within the individual and family therapy treatment modalities. However, this paradigm shift, to produce clinically significant mental health outcomes in a much shorter time, has evolved to a much lesser degree within the treatment group format. Longer-term treatment group protocols typically do not match treatment-seeking behaviors with high dropout rates for clients. The current authors describe a structured, four-session treatment protocol that integrates the tenets of Externalizing Metaphors Therapy (EMT) with Innovative Moments (IMs) in addressing anxiety for children and youth. EMT is based upon the externalization of problems, transformation of metaphoric imagery, and the shifting of underlying maladaptive emotional schemas. It is suggested that treatment outcomes are enhanced through the integration of three IMs between-session exercises.     

Assessment of Biopsychosocial Risk Factors for Medical Treatment: A Collaborative Approach

There is a growing body of evidence that psychosocial variables have a significant ability to predict the outcome of medical treatment procedures, especially when the procedure is performed to reduce pain. The study described in this paper serves as an illustration of the valuable role psychologists can play in dealing with the challenges of biopsychosocial assessment of patients who are candidates for medical treatments, especially elective, invasive procedures. Based on a convergent model of risk factors that can potentially influence outcomes from spinal surgery and spinal cord stimulation, exclusionary and cautionary risk factors were identified, and the BHI 2 and BBHI 2 tests were used to assess them. An estimate of the prevalence of these risk factors was calculated using data obtained from 1,254 patient and community subjects gathered from 106 sites in 36 US states. Standardized Cautionary Risk and Exclusionary Risk scores demonstrated a test-retest reliability of .85 to .91. Evidence of validity of these scores was also provided based on subjective and objective criteria, using multiple groups of patients and community subjects. Recommendations are made regarding how biopsychosocial assessments could be used in collaborative settings for presurgical candidates to identify risks that could compromise a patient’s ability to benefit from other medical treatments as well. Once identified, appropriate interventions could ameliorate these risks, or lead to the consideration of other treatments that are more likely to be effective. Methods of refining this approach for specific clinical applications are also discussed.     

A Complexity Approach To Co-Creating An Innovative Environment

The distinguishing characteristic of complex co-evolving systems is their ability to create new order. In human systems this may take the form of new ways of working or relating, new ideas for products, procedures, artefacts, or even the creation of a different culture or a new organizational form. This article will explore the creation of new order using the principles of complexity and the concepts of creativity and innovation. It will argue that innovation can be facilitated by an enabling environment based on the logic of complexity and describe how one organization (the Humberside Training and Enterprise Council) co-created an innovative environment and changed its culture, ways of working, thinking, and relating.     

Family-Focused Relational Psychotherapy: An Integrative Approach and Its Application to Adult Children of Divorce

This paper presents an integrative model of treatment—family focused relational psychotherapy—and applies it to work with adult children of divorce (ACDs). Three areas of assessment are identified—(a) assessment of individual ego development, (b) assessment of family of origin functioning, and (c) assessment of the nature of the parents' divorce (e.g., level of conflict). Based on this assessment, the treatment model is presented, which integrates strategies from relational/psychodynamic therapy, family of origin work, and experiential techniques. Case examples are presented to demonstrate the appropriate integration of these techniques with clients at different levels in the assessment schema. In addition, a review of the literature on the long-term effects of divorce on children suggests several specific issues that may arise in treatment. These include low self-esteem, emotional distress, externalizing problems, and interpersonal problems such as fear of commitment, difficulty trusting, a high rate of divorce, and strained relationships with parents.     

Toward the Development of Socio-Metacognitive Expertise: An Approach to Developing Collaborative Competence

We proposed and evaluated an instructional framework for increasing students' ability to understand and regulate collaborative interactions called Co-Regulated Collaborative Learning (CRCL). In this instantiation of CRCL, models of collaborative competence were articulated through a set of socio-metacognitive roles. Our population consisted of 28 students from one urban classroom taking part in an 11-week science unit. Our research questions focused on examining the extent to which students understood and used the roles as intended to regulate collaborative interactions to address group process problems. Mixed-methods analysis of collaborative work sessions determined that (a) students generally understood the language and purpose of the roles, (b) students frequently used and accepted the roles to monitor and regulate activity, and (c) students' ability to use the roles to monitor and regulate activity improved over time. This paper contributes to our understanding of socio-metacognition and trade-offs associated to its development in classroom settings.     

Managing Emotional Responses in Therapy: An Adapted EFT Supervision Approach

Therapists often encounter experiences in therapy that elicit emotionality, this could be in the form of self-of-the-therapist issues, compassion fatigue, or professional burnout. Whereas approaches to supervision for self-of-the-therapist issues recognize the need for accessing the supervisee’s emotionality, approaches have not focused on how the clinical and professional system could also be part of the cycle. We propose an adapted emotionally focused supervision approach that employs steps one through six of the EFT model. To display how this approach would work, we provide the example of work with longer-term clients. Working with longer-term clients can be a challenge for many therapists, and both the professional and client system come with factors increasing emotional risk to the therapist. Engaging the therapist’s emotionality through supervision has the potential to improve therapeutic outcomes, as well as reduce loss of good therapists in the field to professional burnout.     

Emotion Regulation Therapy: An Integrative Approach to Treatment-Resistant Anxiety Disorders

Cognitive-behavioral, psychodynamic, and experiential approaches have historically been characterized by differing definitions of emotions and beliefs concerning their role in psychopathological process and treatment. However, given recent advances in the basic psychological sciences of emotion and emotion regulation, theoretical orientations are converging on similar viewpoints as to the functional role of emotions in conceptualizing and treating of a variety of disorders. One such area where emotions and their regulation may play a significant role is in chronic, complex, and treatment-resistant forms of anxiety disorders such as generalized anxiety disorder (GAD). A review of the historical approaches to emotions in the major theoretical orientations is presented. Following this, a model of emotion disruption and dysregulation is presented as it relates to anxiety disorders and GAD, in particular. Finally, a new treatment for GAD, emotion regulation therapy, aimed at ameliorating dysfunctional affective processes, is described.     

Gender and Infertility: A Relational Approach to Counseling Women

Much of the research on infertility reinforces differing effects for women and men, with women reporting more serious repercussions medically, psychologically, and socially. However, the unique counseling needs of infertile women have not been addressed through traditional counseling theory. The Relational Model (J. V. Jordan, 1995) of women's development is a theory that explains women's development in a context of relationships, specifically relationships that promote growth for self and others. This model is applied to counseling women who are experiencing infertility, and a case presentation is provided to illustrate the approach.     

The Alpha-1 Association Genetic Counseling Program: An Innovative Approach to Service

In an era of specialty medicine, genetic counselors are becoming increasingly focused in their service provision. The Alpha-1 Association Genetic Counseling Program, established in September 2007, specializes in confidential toll-free genetic counseling provided by a certified genetic counselor for Alpha-1 Antitrypsin deficiency, a co-dominant condition associated with lung and/or liver disease. The program received more than 600 callers in its first 2 years. Sixty-seven percent of new callers were family members, carriers, or health professionals. The number of callers increased between the first 2 years, with the greatest increases being family members and health professionals. Testing options and explanation of results encompassed 60% of initial reasons for calls. Seventy-two percent of referrals came from family and friends, test result letters, and the Alpha-1 Association. Between year 1 and 2 family member referrals showed the largest increase. This disease-specific genetic counseling program provides a model that may be useful for other rare disease communities.