One-person family therapy? An analysis of family therapy schools

Abstract

In this article, eight schools of family therapy (psychodynamic, intergenerational, contextual, experiential, structural, strategic, functional, behavioral) are examined regarding participation policies. Differences in schools' participation policies are compared and contrasted using comparative and content analyses. Schools' theoretical rationales and how they effect therapy practice are explored. Implications for therapy practice are presented. The study's goal is to provide information to increase therapist flexibility in working with varying client populations.     

A case of therapy by proxy?

Consultancy was offered to a worker requesting help, because of some concern he felt as to how best to progress with a single-parent family where a teenage son with a mental handicap wished to move out and establish himself independently. The situation appeared to us to be 'stuck', with parent and son engaged in a mutually distressing cycle of antagonism with both emotional and physical violence. During the consultancy, communication was established with the parent via messages carried by the worker, and significant change was promoted through these interventions. This work was novel, unusually complex and carried implications for theory, practice and ethics.     

Culturally sensitive therapy? Examining the practice of cross‐cultural family therapy

This article is drawn from a research project that examines cross‐cultural family therapy sessions in order to consider what constitutes culturally sensitive practice. A discourse analytic approach was adopted in the analysis of three sessions from two families where the family and the therapists originated from different ethnic backgrounds. This article is based around part of the research findings connected to one of the families, and focuses upon the ways in which ‘culture’ is talked about in therapy (the term ‘culture’ will be referred to in inverted commas in order to acknowledge its complexity as is emphasized in this article). This allows for an examination of the cultural assumptions that we hold as therapists, which are enacted in therapy with effects on all participants and upon the course of the therapy. The value of qualitative research methods in examining the cultural assumptions we bring to therapy is highlighted as one way of improving culturally sensitive therapeutic practice, especially with regard to therapist reflexivity.     

A review of outcome studies of rational-emotive therapy from 1982–1989

In 1977, DiGiuseppe and Miller provided a review of the literature assessing the effectiveness of Rational-Emotive Therapy (RET). In 1984, McGovern and Silverman completed a similar review for outcome studies conducted from 1977 through mid-1981. This present study is meant as a continuation of those reviews. The 89 studies reviewed are divided into three sections: outcome studies that do not compare Rational-Emotive Therapy with other types of treatment; a review of outcome studies that do compare RET with other types of psychotherapy; and a review of Rational-Emotive outcome studies that either combine RET with other therapies or are not appropriate for the first two sections. There does appear to be some increased sophistication in the research conducted since 1982. Increases were noted in the number of control groups used in the current research as well as in the number of follow-up studies. There also appears to be an improvement in the comparison of RET with other forms of therapy, and the number of problem areas in which RET has been tested has increased. A decrease in post-test only studies and an increased variety of subjects have also improved the current research. Issues such as socioeconomic status and I.Q. of subjects, duration of treatment, and lack of longitudinal studies remain unaddressed. It is suggested that future researchers concentrate on these specific problems to improve the credibility of RET. This review coincides with the previous findings that RET is a valuable, effective therapy that warrants increased research to broaden its application.Manuel S. Silverman, Ph.D., is a Professor of Counseling Psychology at Loyola University Chicago.Margaret M. McCarthy, M.A., is a recent graduate of Loyola University Chicago.Terrance McGovern, Ph.D., is in Private Practice in Downers Grove, Illinois.     

The Judaic foundations of rational–emotive behavioural therapy

This paper will explore the connections between rabbinical Judaism, rational–emotive behavioural therapy (REBT), and related forms of cognitive-behavioural therapy (CBT). Seven main themes are identified. Both the Judaic tradition and REBT/CBT emphasised that honest and accurate self-understanding are the keys to self-improvement; that the intellect is capable of directing the emotional faculties; that an individual's overt behaviours and actions can influence his thoughts and emotions; that one should cultivate self-sufficiency and acceptance of one's circumstances; that all individuals have intrinsic and unalienable value as human beings; that happiness and unhappiness are internally caused; and finally, that immediate gratification is ultimately not reliable a source of self-fulfilment.     

A content analysis of person‐centered expressive therapy outcomes

Abstract

This study is a content analysis and follow‐up of thirty‐two former participants in multi‐modal expressive therapy training workshops conducted by the Person‐Centered Expressive Therapy Institute. The theoretical foundation of the study is based on Carl Rogers’ concept of the “significant learning” and Natalie Rogers’ concept of the “creative connection.” The expressive therapy applies core conditions of acceptance, empathic understanding, and congruence in a learning setting that uses writing, visual arts, drama, music and dance. Narratives of significant incidents were analyzed phenomenologically. Results revealed important learnings and shifts of self‐perceptions towards greater self‐awareness, improved self‐confidence, risk‐taking, deeper self‐exploration and appreciation for the process involved in the creative act. This qualitative study shows expressive therapy as making an important contribution to person‐centered theory and practice.     

Internet-based cognitive behavioral therapy for anxiety in an outpatient specialized care setting: A qualitative study of the patients’ experience of the therapy

Knowledge about user experiences of internet-based cognitive behavioral therapy (iCBT) has mostly been drawn from non-clinical groups or with iCBT offered via self-referral. The present study therefore focused on patients who had undergone iCBT with minimal support while actively awaiting outpatient psychological treatment in the form of face-to-face CBT. To seek out barriers to adherence the study also included patients who had withdrawn from the iCBT treatment before completion. The study was performed in an outpatient clinic for anxiety disorders where twelve participants with a primary diagnosis of either social anxiety disorder or panic disorder were recruited from an ongoing randomized control trial for semi-structured interviews. Statements from the interviews showed that the iCBT treatment was unfavorably compared to the usual face-to-face treatment at the clinic. Despite this, a majority of the interview participants still expressed to have experienced various benefits from the treatment. Some participants did however, experience difficulties putting the materials to practical use. Furthermore, a large majority of the participants expressed a need for additional support, with a strong tendency for non-completers specifically expressing a need for face-to-face contact with a clinician. Implications for future research and implementation of iCBT in clinical practice are discussed.     

“Bridging the Gap”: A reflexive thematic analysis of the experiences of therapy trainees transitioning from psychodynamic counselling to cognitive behavioural therapy

There is limited empirical research and insight into the experiences of therapy trainees who are being taught more than one psychotherapeutic approach during their training. Further understanding is warranted to ensure that a dual modality approach to training (that is, where therapists are trained in two paradigmatically distinct modalities) is experienced as worthwhile and acceptable to trainees and to better understand any challenges faced when transitioning between approaches. The aim of this study was to investigate trainees' experiences of transitioning from psychodynamic counselling to cognitive behavioural therapy (CBT) on a two-year master's degree that offers a dual modality approach to training. Data were collected from a sample of 8 trainees using an online semistructured questionnaire. These data were analysed using Braun and Clarke's (2020) reflexive thematic analysis. Four main themes were identified: (1) perceived competence; (2) preparedness; (3) professional advantages; and (4) external challenges. The findings suggested considerable individual variation in the ease with which participants navigated the transition between therapeutic modalities. Those who found the transition easier used the structure of CBT to provide a framework and point of difference that allowed them to temporarily suspend their psychodynamic learning in order to embrace a new therapeutic approach. Others experienced the move to CBT as posing a threat to their developing identities as counsellors. Recommendations are made on how to prepare trainees for the transition including exploring the psychological impact of transitions, increasing opportunities for reflective practice and facilitating exploration of what it means to be a therapist trained in two distinct therapeutic modalities.     

Child-oriented family therapy in China: A cross-cultural application of integrative family therapy targeting children aged 4–10

This article describes child-oriented family therapy (COF), a family therapy approach to early psychological and behavioral problems that is widely applied in northern Europe and has been adopted by countries with different cultures, such as Germany and China. This article explains the theoretical background, setting, characteristics, development and effective factors of this method and explores relevant research. In addition, the application of this method in China and reflections on its applicability to families in different cultures are presented. A clinical case is provided to illustrate the core therapeutic principles of COF. Since the application of COF interventions to families with children in Asian cultures remains understudied, the widespread availability of COF and adaptation to local conditions could facilitate training and research achievements in this field.     

Does family therapy produce change? an overview of outcome studies

Summary Families were randomly assigned to one of two forms of conjoint marital therapy: an insight-oriented treatment (n=10) or a problem-solving intervention (n=10.). The results on self-report measures of family functioning indicate that the problem-solving intervention produced more favorable changes after three months. However on long-term follow-up after a year, this more positive effect did not apparently persist, since the insight treatment group reported better results. Experienced therapists did better than inexperienced therapists in the insight treatment condition, but level of experience did not make a difference in the problem-solving intervention. A group of eight families who dropped out of the insight treatment group provided data on correlates of premature termination. Several of the practical obstacles to implementing an experimental design in a clinic setting are illustrated by the research.As we develop more sophisticated methodology, we hope that is the near future family therapy researchers will be better able to state which type of approach is more effective for whom and under what circumstances. A review of current studies of family therapy outcome research indicates that family therapy seems to be as effective as individual psychological treatment.     

Öst's (2008) methodological comparison of clinical trials of acceptance and commitment therapy versus cognitive behavior therapy: Matching Apples with Oranges?

Öst (2008) recently compared the methodological rigor of studies of acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (CBT). He concluded that the ACT studies had more methodological deficiencies, and thus the treatment did not qualify as an “empirically supported treatment.” Although Öst noted several important limitations that should be carefully considered when evaluating early ACT research, his attempt to devise an empirical matching strategy by creating a comparison sample of CBT studies to bolster his conclusions was itself problematic. The samples were clearly mismatched in terms of the populations being treated, leading to differences in study design and methodology. Furthermore, reanalysis showed clear differences in grant support favoring CBT compared with ACT studies that were not reported in the original article. Given the actual mismatch between the samples, Öst's methodological ratings are difficult to interpret and provide little useful information beyond what could already be gathered by a qualitative review of ACT study limitations. Such limitations are characteristic of the earlier randomized controlled trials of any emerging psychotherapeutic approach.     

Ready or not? Stages of change as predictors of brief group therapy outcome in bulimia nervosa

Although group therapy is often recommended for the treatment of bulimia nervosa, relatively little is known about predictors of short-term outcome. This pilot study examined whether a standardized measure of readiness for change might be related to changes in binge frequency. Sixteen bulimic patients participated in short-term cognitive behavioral group therapy for twelve weeks. Each patient completed the Change Assessment Scale prior to treatment, along with a battery of symptom measures which were readministered at the conclusion of therapy. Bulimic patients with positive outcome in binge frequency were at a higher stage of readiness for change at pretreatment than were patients with negative outcome. Results indicated that there may be methods of determining who would be most likely to benefit from cognitive behavioral group therapy, and tentatively suggest that interventions may be more successful when readiness for change is taken into consideration.     

Comparison of “rap” groups with traditional group therapy in the treatment of Vietnam combat veterans

An estimated 500,000–700,000 veterans suffer from posttraumatic stress disorder characterized by mental flashbacks of the war, recurrent dreams of the trauma, repetitive, intrusive thoughts of the war, irritability, generalized anxiety and difficulty relating to others. For many years, these individuals went undiagnosed and, except for rap groups, untreated. The rap groups were formed to talk about the war in a general debriefing process during the early 1970s. Rap groups failed to focus on the individual pathology, but, instead, provided a forum to refashion value and meaning in the veterans' lives. Recently, more traditional forms of group therapy have been used to help treat individuals suffering from posttraumatic stress disorder secondary to the Vietnam war. This paper discusses the unique features of traditional group therapy with Vietnam veterans.     

Challenging anxious cognitions or accepting them? Exploring the efficacy of the cognitive elements of cognitive behaviour therapy and acceptance and commitment therapy in the reduction of children's fear of the dark

Anxiety is highly prevalent in pre-adolescent children. Distorted cognitions are characteristic for dysfunctional levels of anxiety. However, applying cognitive elements in pre-adolescent children cannot be fully ascertained, as it is not until adolescence before children can apply logical and abstract reasoning in a sophisticated manner. Cognitive behaviour therapy (CBT) and acceptance and commitment therapy (ACT) both target distorted cognitions. Whereas CBT encourages children to change the content of negative cognitions by applying cognitive restructuring, ACT stimulates youth to have a more accepting attitude towards these thoughts by applying cognitive defusion. The current study examined the efficacy of applying cognitive elements and compared the cognitive elements of CBT and ACT in pre-adolescent children. We included no behavioural elements to specifically study the developmental appropriateness of the cognitive elements in this age group. Highly anxious children, aged 8–12 years were randomised to a 30-minute cognitive restructuring (n = 21) or cognitive defusion intervention (n = 22). Subjective fear of the dark levels, behavioural darkness toleration, and comprehension and fun associated with the interventions were assessed. Both interventions had a significantly positive impact on children's fear of the dark. Cognitive restructuring led to more favourable results on subjective fear than cognitive defusion, no differences were found for darkness toleration.     

Can the medical resonance therapy music affect autonomous innervation of cerebral arteries?

The purpose of this investigation was to study the effects of Medical Resonance Therapy Music (MRT-Music) upon autonomous innervation of cerebral arteries by examining slow spontaneous oscillations of cerebral blood flow (SSO) using transcranial Doppler ultrasound (TCD). TCD detects SSO with 3–9 cycles per minute (M-waves) and 0.5–2 cycles per minute (B-waves). The SSO are caused by rhythmic diameter changes of the medium and small cerebral arteries. Six patients aged 24–65 years suffering from tension headache were treated with MRT-Music. Twelve additional patients were examined with TCD only to register SSO for further spectral analysis. After fast Fourier transformation four groups of peaks were registered on the SSO spectra, divided into four rhythms: A. 0.0–0.02 Hz, B. 0.02–0.033 Hz, C. 0.06–0.09 Hz, D. 0.09–0.15 Hz and an intermediate diapason of 0.034–0.059 Hz. Spectral analysis of the SSO showed changes between initial and final amplitude peaks in all patients. In contrast to A-, B-and D-rhythms, the reduction of peaks in the C-diapason was statistically significant (31–60%, P 3D0.04, CI 3D95%) for patients treated with MRT-Music. All patients treated with the MRT-Music reported a relief of headache while and after treatment.     

Does enhanced cognitive behaviour therapy for eating disorders improve quality of life?

Quality of life (QOL) is the degree of enjoyment and satisfaction experienced in life, and embraces emotional well-being, physical health, economic and living circumstances, and work satisfaction. QOL recovery with eating disorder treatment has received sparse attention, and until now, no study has investigated QOL recovery with enhanced cognitive behaviour therapy (CBT-E). Patients (n?=?196) admitted to a specialist eating disorders outpatient programme and receiving CBT-E completed measures of QOL, eating disorder psychopathology, depression, anxiety and self-esteem, before and after treatment. QOL at intake was compared with community norms, and QOL below the norm was predicted from sociodemographic and clinical correlates with logistic regression. Baseline QOL below the norm was associated with depression and anxiety Axis I comorbidity, and severity of depressive symptoms. Predictors of post-treatment QOL were baseline QOL and level of depressive symptoms and self-esteem at post-treatment. CBT-E was associated with gains in QOL over the course of treatment, in addition to eating disorder symptom relief. Copyright ? 2012 John Wiley & Sons, Ltd and Eating Disorders Association.