Ideologies,Idols (and Graven Images?): Rejoinder to Gurman and Kniskern

Three major issues raised in Gurman and Kniskern's commentary are discussed. These are (a) the suitability of established research design criteria for studying the outcome of family therapy; (b) the impact of therapist relationship factors on therapy outcome; and (c) the place of concrete or objective change measures in psychotherapy outcome research. Areas of agreement and disagreement with Gurman and Kniskern's observations are identified.     

Family therapy outcome research: a trial for families, therapists, and researchers

This article describes the process of an evolving research project. Initially conceived as a study investigating outcome measures and their sensitivity to change after a course of family therapy, the project soon changed its focus. As unexpected results were recorded, the clinical research team became destabilized and the individual team members responded by making their own "sense" of the data, reflecting their respective clinical and scientific positions. As clinicians and researchers began to challenge each other's belief systems, the project entered a new stage. The interactions within the team became of increasing interest and themselves objects of research. The recursive nature of re-search was demonstrated, and the act of writing this report completed the circle, as the various authors tried to achieve a balance between reporting the content and the process of this project.     

Guidelines for classifying evidence-based treatments in couple and family therapy

Guidelines for Evidence-Based Treatments in Family Therapy are intended to help guide clinicians, researchers, and policy makers in identifying specific clinical interventions and treatment programs for couples and families that have scientifically based evidence to support their efficacy. In contrast to criteria, which simply identify treatments that "work" and have been employed in the evaluation of other psychotherapies, these guidelines propose a three-tiered levels-of-evidence-based model that moves from "evidence-informed," to "evidence-based," to "evidence-based and ready for dissemination and transportation within diverse community settings." Each level reflects an interaction between the specificity of the intervention, the strength and readth of the outcomes, and the quality of the studies that form the evidence. These guidelines uniquely promote a clinically based "matrix" approach in which the empirical support is evaluated according to various dimensions including strength of the outcomes, the applicability across cultural contexts, and demonstration of specific change mechanisms. The guidelines are offered not only as a basis for understanding the evidence for diverse clinical approaches in couple and family therapy within the systemic tradition of the field, but also as an alternative aspirational model for evaluating all psychotherapies.     

Families of persons with Down syndrome: new perspectives, findings, and research and service needs

To understand the families of offspring with Down syndrome, this article begins by describing the change in orientation--from "negative" to "stress-and-coping" perspectives--in studies of families of offspring with disabilities. In reviewing the existing studies, mothers, fathers, and siblings cope slightly better than family members of persons with other disabilities, a phenomenon called the "Down syndrome advantage." Beyond this more general finding, however, much remains unknown. Most studies examine only parental or sibling levels of stress or coping, leaving unknown the marital, occupational, health, educational, and other "real-world" outcomes for these family members. Increased research attention is needed to understand the life-span needs of families of persons with Down syndrome and the impact of cultural and sociocultural diversity on family outcomes. It will also be important to relate family outcomes to differences in the offspring's behaviors, development, relationships, medical conditions, psychopathology, and the presence (and effectiveness) of needed support services. Although these families have received some research attention over the past several decades, we now need to make family research in Down syndrome more concrete, more life-span, and more tied to characteristics of the individual with the syndrome and the family's surrounding support system.     

Individual Marital Therapy — Have Reports of your Death been Somewhat Exaggerated?

In this reply to Wells and Giannetti's critique of our earlier reviews of research in family therapy, we demonstrate that the sense of absolute certainty with which they reappraise and dismiss as useless the studies we reviewed on individual marital therapy is unjustified. We also consider the implications of their critique and the conclusions they derive from it for public policy and clinical practice. Though we acknowledge the appropriateness of certain aspects of their critique, we continue to hold to our original position that, for now, there is ample empirical warrant for considering conjoint therapy to be the treatment of choice for marital problems.     

Cognitive therapy for social phobia: individual versus group treatment

Cognitive-behavioural group treatment is the treatment of choice for social phobia. However, as not all patients benefit, an additional empirically validated psychological treatment would be of value. In addition, few studies have examined whether a group treatment format is more effective than an individual treatment format. A randomized controlled trial addressed these issues by comparing individual cognitive therapy, along the lines advocated by Clark and Wells (Clark, D.M. and Wells, A., 1995. A cognitive model of social phobia. In: R. G. Heimberg, M. Liebowitz, D. Hope and F. Schneier (Eds.), Social Phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York: Guilford.), with a group version of the treatment and a wait-list control condition. 71 patients meeting DSM-IV criteria for social phobia participated in the trial, 65 completed the posttreatment assessment and 59 completed a six-month follow-up. Social phobia measures indicated significant pretreatment to posttreatment improvement in both individual and group cognitive therapy. Individual cognitive therapy was superior to group cognitive therapy on several measures at both posttreatment and follow-up. The effects of treatment on general measures of mood and psychopathology were less substantial than the effects on social phobia. The results suggest that individual cognitive therapy is a specific treatment for social phobia and that it's effectiveness may be diminished by delivery in a group format.     

Family-based treatment for adolescent substance abuse: controlled trials and new horizons in services research

This article provides an overview of controlled trials research on treatment processes and outcomes in family-based approaches for adolescent substance abuse. Outcome research on engagement and retention in therapy, clinical impacts in multiple domains of adolescent and family functioning, and durability and moderators of treatment effects is reviewed. Treatment process research on therapeutic alliance, treatment fidelity and core family therapy techniques, and change in family processes is described. Several important research issues are presented for the next generation of family-based treatment studies focusing on delivery of evidence-based treatments in routine practice settings.     

Marital therapy outcome measured by therapist, client, and behavior change

The present research examined marital therapy outcome, in a sample of 88 couples and 22 therapists, through the use of multidimensional criteria from multiple perspectives. Three paper-and-pencil patient self-report instruments were used to measure different aspects of the couple relationship. In addition, therapist post-therapy ratings and objective observer ratings of the couple behavior during therapy were obtained. Past debates about what the "right" criteria might be for measuring therapeutic change prompted our strategy. Special attention was focused on those criteria that could be classified as "inside" or "outside" of the couple relationship. Data analysis revealed a significant relationship between the couples' and therapists' ratings of improvement in therapy. Additionally, husband and wife negative acts (behaviors) in therapy were also significantly correlated with therapists' ratings of improvement. Both statistically significant and clinically significant criteria were employed to evaluate the therapy outcome. Improvement due to therapy as measured by the three self-report instruments varied from 38% to 58%. These differences appeared to stem from the different kinds of information yielded by the specific tests.     

Family therapy as a treatment for children: a critical review of outcome research.

The value of family therapy as a treatment for child psychopathology is considered by reviewing pertinent outcome research. Fourteen studies that met three criteria are included in the review: (a) a child or adolescent was the identified patient or referral; (b) therapy included at least one parent and the child; and (c) outcome was evaluated in terms of the child's symptoms. There are major shortcomings in most of the available data, with only two well-controlled studies. Some empirical evidence does exist that family therapy is an effective treatment for children; the data from studies of adolescents are especially encouraging. However, insufficient data are available for comparing the relative merits of conjoint family treatment and individual child therapy. If the value of family therapy as a treatment alternative or, ideally, as the "treatment of choice" for a referred individual child is to be established, more and better controlled comparative outcome studies will be necessary. Suggestions for future research are presented emphasizing the need for a developmental perspective by recommending, for example, the use of factorial designs in which the intervenaction of treatment and age can be analyzed.     

A Critical Methodological Review of Discourse and Conversation Analysis Studies of Family Therapy

Discourse (DA) and conversation (CA) analysis, two qualitative research methods, have been recently suggested as potentially promising for the study of family therapy due to common epistemological adherences and their potential for an in situ study of therapeutic dialog. However, to date, there is no systematic methodological review of the few existing DA and CA studies of family therapy. This study aims at addressing this lack by critically reviewing published DA and CA studies of family therapy on methodological grounds. Twenty‐eight articles in total are reviewed in relation to certain methodological axes identified in the relevant literature. These include choice of method, framing of research question(s), data/sampling, type of analysis, epistemological perspective, content/type of knowledge claims, and attendance to criteria for good quality practice. It is argued that the reviewed studies show “glimpses” of the methods’ potential for family therapy research despite the identification of certain “shortcomings” regarding their methodological rigor. These include unclearly framed research questions and the predominance of case study designs. They also include inconsistencies between choice of method, stated or unstated epistemological orientations and knowledge claims, and limited attendance to criteria for good quality practice. In conclusion, it is argued that DA and CA can add to the existing quantitative and qualitative methods for family therapy research. They can both offer unique ways for a detailed study of the actual therapeutic dialog, provided that future attempts strive for a methodologically rigorous practice and against their uncritical deployment.     

Students’ achievement values,goal orientations,and interest: Definitions,development, and relations to achievement outcomes

Students’ achievement task values, goal orientations, and interest are motivation-related constructs which concern students’ purposes and reasons for doing achievement activities. The authors review the extant research on these constructs and describe and compare many of the most frequently used measures of these constructs. They also discuss their development during childhood and adolescence. They review the research on the relations of these constructs to achievement outcomes, and their relations to each other both contiguously and over time. Suggestions for future research include testing theoretically derived predictions about how students’ achievement values, goal orientations, and interest together predict various achievement outcomes; and examining how their relations with one another become established and change over time.     

Turning differences into possibilities: Using discourse analysis to investigate change in therapy with adolescents and their families

Discourse analysis affords researchers and practitioners improved understandings regarding how positive outcomes are accomplished in the conversations of family therapy. By investigating how change is constructed or ‘performed’ in therapeutic interactions, its analyses conceptually parallel those of the social constructionist approaches to family therapy. In this respect, discourse analysis offers empirical methods to examine claims about the constructive aspects of therapeutic conversations. These conceptual and research parallels are examined in how impasses in family therapy were transcended, rhetorically, between an adolescent, his parents and the therapist. We conclude that the research methods of discourse analysis can directly enhance the conversational skills and methods of therapists.     

Detrimental therapist-client relationships--beyond thinking of "dual" or "multiple" roles: reflections on the 2001 AAMFT Code of Ethics

This article presents reflections on and a critique of the recent revision of the AAMFT Code of Ethics on the multiple relationship ethical standard. A brief historical overview of terminology and the debate surrounding "dual" and "multiple" relationship ethical rules in marriage and family therapy is provided. The term "exploitation" is also delimited. Ethical principles and a set of standards addressing "detrimental" versus "potentially beneficial" interactions are introduced, deriving from works in other mental health professions. The article recommends: (a) the terms "dual" and "multiple" relationships should be abandoned; (b) the ethical principles underlying the AAMFT Code of Ethics need to be examined; and (c) the debate on the topic of detrimental therapist-client interactions in marriage and family therapy needs to be revisited, especially in light of a "positive ethics."     

Understanding Social Anxiety Disorder in Adolescents and Improving Treatment Outcomes: Applying the Cognitive Model of Clark and Wells (1995)

Social anxiety disorder is a condition characterised by a marked and persistent fear of being humiliated or scrutinised by others. Age-of-onset data point to adolescence as a developmentally sensitive period for the emergence of the condition, at a time when the peer group becomes increasingly important. Social anxiety in adolescence is associated with considerable impairment that persists through to adulthood. There are clear potential benefits to delivering effective interventions during adolescence. However, there is limited evidence on the specific efficacy of available therapies. This is in contrast to adults, for whom we have interventions with very specific treatment effects. One such treatment is individual cognitive therapy. Cognitive therapy is based on the cognitive model of social anxiety proposed by Clark and Wells (in: Heimberg, Leibowitz, Hope, Scheiber (eds) Social phobia: diagnosis, assessment and treatment, The Guilford Press, New York, 1995). The present review examines the potential application of this adult cognitive model to the understanding of adolescent social anxiety and considers additional adolescent-specific factors that need to be accommodated. It is suggested that a developmentally sensitive adoption of the cognitive model of social anxiety disorder (Clark and Wells 1995) for adolescents may lead to better treatment outcomes.     

The Effects of Work-Related and Boundary-Related Stress on the Emotional and Physical Health Status of Ordained Clergy

This research is the second component of a three-part series that explores the relationship between stress and health in the clerical profession. The first article (Wells, Journal of Religion and Health 51(1):215–30, 2012) determined that there is an association between two different sources of stress in the clerical profession (work-related stress and boundary-related stress). This research explores the association between these two sources of stress and two different measures of health (emotional health and physical health). Utilizing the same dataset from the previous research (Wells, Journal of Religion and Health 51(1):215–30, 2012), and simple and multiple regression, this research determined that there is a positive association between the two sources of stress (work-related stress and boundary-related stress) and the two measures of health (physical health and emotional health). African-American and obese clergy exhibited lower levels of physical health as stress increased. Clergy with children and those with higher levels of education exhibited lower levels of emotional health as stress increased. African-American clergy consistently exhibited higher levels of emotional health than their White colleagues did. Finally, age and length of time in ministry are associated with higher levels of emotional health but lower physical health status.     

Facilitated Parent-child Groups as Family Support: A Systematic Literature Review of Supported Playgroup Studies

Supported playgroups are community-based services that provide low intensity family support, through regular group sessions for parents and their young children. Led by a playgroup facilitator, the program aims to enrich children’s early learning, enhance positive parenting behaviors, provide social connections for parents, and enable access to other community services. Despite high community acceptance and government investment, little is known about the extent to which such services are effective. This paper reports findings from a systematic review of research on supported playgroups and their effectiveness to improve child, parent, and community outcomes. Thirty-four studies were included, of which 28 were conducted in Australia. Programs targeted a diverse range of families who were considered socially disadvantaged. Seven studies employed experimental or quasi-experimental designs from which reliable evidence for effectiveness could be established. A high proportion of studies were qualitative and included action research, case studies, or ethnographies. A range of qualitative and quantitative measures were used to assess child, parent, and community outcomes. While findings suggested that supported playgroup programs were highly valued by parents and other stakeholders, rigorous evidence of effectiveness for achieving desired improvements in child outcomes or parenting behavior was rare and limited by low quality study designs. More explicit theories of change about how different types of supported playgroup programs can meet diverse family needs are required. Such theories of change would provide directions for specific content and delivery approaches that could address and improve different child and parent outcomes targeted to specific populations of attending families.     

Delinquency prevention through training parents in family management

Nearly two decades of clinical research at the Oregon Social Learning Center (OSLC) have helped to shape a theory of antisocial behavior in boys. Models depicting the theory are presented and discussed. In addition, family management variables such as "discipline," "monitoring," "positive parenting," and "problem solving" are described as used in clinical applications. Total aversive behavior (TAB), based on home observations, and parent daily report (PDR), based on telephone interviews, are examined as outcome indicators for a variety of studies investigating the efficacy of the OSLC social interactional therapy. Several recent reports of treatment for adjudicated adolescents and their families are included; law violations are the dependent measures in those studies. Examples of the interface between clinical work and theory at OSLC are presented. Questions of generalization of the clinical methodology to large urban populations, and access to parents who most need to learn the parenting techniques are noted.