Family Therapy Training: Program and Outcome

A family therapy training program has been conducted for staff of mental health agencies located throughout Pennsylvania. This paper is a report on the content and results of the four-year-old training program. Three hundred practitioners have been trained in family therapy. The program has also led to the development of a core group of 64 family therapy trainers. There has been an associated delivery of more family-oriented mental health services throughout the Commonwealth.     

On the Boundary: Family Therapy in a Long-Term Inpatient Setting

This paper presents a paradigm of family therapy in a long-term inpatient setting. After reviewing literature commenting on the necessity of attending to the needs of families of inpatients, the essential functions of inpatient treatment are discussed and an approach to family therapy, related to and reflecting those functions, is developed. Four functions of inpatient family therapy are delineated: joining, support, intervention, and validation. What distinguishes these from similar functions in outpatient treatment is the family therapist's position on the hospital-family boundary.     

Divorced Parents in Family Therapy in a Residential Treatment Setting

Divorced parents are required to participate together in the family therapy of their child placed in a residential treatment center. Different sources of resistance and treatment techniques are identified and discussed through a theoretical analysis and case study material. The therapy of these fractured families contributed to an elimination of recidivism and, according to followup reports, to significant and sustained improvement in the children's functioning in school, home, and community activities.     

Families Leaving Family Therapy After One or Two Sessions: A Multiple Descriptive Case Study

A multiple case study design was used to discover something of the experiences of families, therapists, and members of the reflecting team of the first and or second session of family therapy in an attempt to answer questions regarding why families drop out after only one or two sessions. It was found that the families attending these sessions found them to be ineffective in assisting them to re-author the stories of their lives. There many reasons for this being the case.     

Medical Family Therapy in a Primary Care Setting: A Framework for Integration

As the profession of marriage and family therapy (MFT), as well as the emerging sub-specialty of medical family therapy (MedFT), continue to grow and evolve within the current healthcare system, the arena of integrated primary care (IPC) presents an ideal environment for professionals who are relationally and systemically inclined. Although there has been a inundation of literature detailing collaborative systems of healthcare, several gaps still exist: (a) a lack of horizontally integrated models (i.e., models that do not target specific diseases or demographic populations), (b) a lack of model utilization regardless of disease trajectory (i.e., decline, stabilization, improvement), and (c) a lack of IPC models explicitly utilizing MedFT/MFTs as the mental health providers within the system. In lieu of these gaps, the authors present a framework for IPC, utilizing MedFTs/MFTs, that is neither population nor disease specific, as well as a model geared towards implementation regardless of disease trajectory. The framework, which was obtained using ethnography of communication, details MedFTs?? interactions with front line medical providers and patients from initial contact through coordination of a shared treatment plan. Recommendations for future research studies incorporating the use of MedFTs in integrated primary care settings are extended in the context of a three world view framework (Peek in Collaborative medicine case studies: Evidence in practice. Springer, New York, pp 25?C38, 2008; Peek and Heinrich in Family Syst Med 13:327?C342, 1995, Integrated primary care: the future of medical and mental health collaboration. Norton, New York, pp 167?C202, 1998).     

Internet-Based Cognitive Behaviour Therapy for Tinnitus Patients Delivered in a Regular Clinical Setting: Outcome and Analysis of Treatment Dropout

Cognitive behaviour therapy (CBT) can reduce tinnitus distress but is not available for most patients. Therapist guided, internet-based CBT (ICBT) increase availability and has been shown to be effective. However, the initial positive results need to be replicated in larger samples, and treatment dropout has not been thoroughly studied. Moreover, it has not been evaluated if a low-intensity version of ICBT without therapist contact could be an alternative for patients who do not need or are able to manage the full ICBT-program. This study evaluated two parallel interventions delivered in regular care: ICBT for tinnitus distress (n = 293) and a low-intensity version of ICBT (n = 81) for patients with lower levels of tinnitus distress. We also explored predictors of dropout from ICBT and if dropout influences outcome. Tinnitus Reaction Questionnaire (Wilson, Henry, Bowen, & Haralambous, 1991) was used as the primary outcome. Secondary outcomes were measures of depression, anxiety, sleep, and sound sensitivity. Significant reductions following ICBT were found on all measures after treatment and also at a three-month follow-up. Patients receiving low-intensity ICBT showed a significant reduction in distress, even when they had low levels of distress initially. Treatment dropout was preceded by an increase in days spent at each treatment step but not by an increased distress. Early dropout was related to worse outcome. ICBT can be used in a regular clinical setting to reduce tinnitus distress. Early dropouts may need additional management. For help-seeking patients with lower distress, a low-intensity version of ICBT can be used.     

For Better or Worse: Fundamentalists' Attitudes Toward Outgroups as a Function of Exposure to Authoritative Religious Texts

Fundamentalism not only predicts prejudice toward outgroups but also prosociality toward proximal targets and ingroups. Taking things a step further, we hypothesized that because fundamentalists tend to show submission to religious authority, their attitudes toward unknown targets and outgroups may vary significantly depending on the nature of the authoritative religious texts to which they are exposed. In three studies using hypothetical scenarios, the association between fundamentalism and prosocial attitudes (a) became negative after exposure to a violent biblical text (Study 1; unknown targets), (b) reversed from negative to positive after reading a prosocial biblical text (Study 2; negligent targets), and (c) became negative or positive following a violent versus prosocial biblical text (Study 3; atheist target). Additional results confirmed the uniqueness of fundamentalism compared to general religiosity, quest orientation, and authoritarianism, regarding such dependency upon religious authority. Findings also support the mediating roles of reported submissiveness to religious teachings and perceived symbolic threat.     

Issues in the Assessment of Outcome in Family Therapy

This paper examines several issues in family therapy outcome research. These include the need to consider numerous population and treatment variables, the influence of treatment goals and values upon the research, the difficulties in defining and operationalizing family treatment, the choice between emphasizing integrity of treatment or randomness of sampling, the selection of measurement methods, the controls needed in research design, the extent of generalizability of results, the importance of efficiency of treatment, and the special role of deterioration effects. Throughout, the need for a multivariate schema for conceptualizing this research and special attention to the role of values and assumptions in it are highlighted.     

Need for Family Therapy Services for Middle-Class Families in India

This qualitative study explored the needs of Indian middle-class families for family therapy services. Four focus group interviews were conducted with middle-class parents in Madras, India. Participants were introduced to the concept and practice of family therapy and were encouraged to take a more active role in supporting the services they suggested. Participants identified problems faced by Madras middle class families and five different types of services that they were aware of. Three categories of need for family therapy were identified from the narratives of the participants. Several themes fit in each of the three categories. Implications for clinical application are discussed.     

Cognitive Behavioral Therapy for Social Anxiety Disorder: Predictors of Treatment Outcome in a Quasi-Naturalistic Setting

We examined the outcomes of individual cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) in a sample of 93 adults seeking treatment in a university outpatient clinic specializing in CBT for SAD. Treatment followed the structure of a manual, but number of sessions varied according to client needs. After approximately 20 weeks of therapy, patients’ social anxiety had decreased and their quality of life had increased. Patients with more severe SAD or comorbid major depressive disorder (MDD) at pretreatment demonstrated higher levels of social anxiety averaged across pre- and posttreatment. However, clinician-rated severity of SAD, comorbid MDD, or comorbid generalized anxiety disorder did not predict treatment outcome. Higher pretreatment scores on measures of safety behaviors and cognitive distortions were associated with higher social anxiety averaged across pre- and posttreatment and predicted greater decreases from pre- to posttreatment on multiple social anxiety outcome measures. We found no predictors of change in quality of life. Those with high levels of safety behaviors and distorted cognitions may benefit more from CBT, perhaps due to its emphasis on targeting avoidance through exposure and changing distorted thinking patterns through cognitive restructuring methods. Our study lends support to the body of research suggesting that manualized CBT interventions can be applied flexibly in clinical settings with promising outcomes for patients over a relatively short course of therapy.