Advancing Medical Family Therapy Through Research: A Consideration of Qualitative, Quantitative, and Mixed-Methods Designs

To survive in today??s healthcare climate, stakeholders across all mental health disciplines must work to produce empirical evidence that earns their fields?? regard by educators, providers, and policy makers. As the field of Medical Family Therapy (MedFT) answers this call, it will be important for researchers to clearly define, characterize, and assess MedFT practice across clinical, operational, and financial arenas of care. In this account, we propose a common lexicon from which to do this, highlighting the following core tenets of MedFT: systems theory, biopsychosocial-spiritual sensitivity in practice, agency, communion, interdisciplinary collaboration, and the three-world model of healthcare. We conclude by offering concrete ways to advance the MedFT research agenda using qualitative, quantitative, and mixed-method approaches.     

Multidimensional Family Therapy HIV/STD Risk-Reduction Intervention: An Integrative Family-Based Model for Drug-Involved Juvenile Offenders

Drug and juvenile justice involved youths show remarkably high rates of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) risk behaviors. However, existing interventions aimed at reducing adolescent HIV risk behavior have rarely targeted these vulnerable young adolescents, and many approaches focus on individual-level change without attention to family or contextual influences. We describe a new, family-based HIV/STD prevention model that embeds HIV/STD focused multifamily groups within an adolescent drug abuse and delinquency evidence-based treatment, Multidimensional Family Therapy (MDFT). The approach has been evaluated in a multisite randomized clinical trial with juvenile justice involved youths in the National Institute on Drug Abuse Criminal Justice Drug Abuse Treatment Studies ( http://www.cjdats.org ). Preliminary baseline to 6-month outcomes are promising. We describe research on family risk and protective factors for adolescent problem behaviors, and offer a rationale for family-based approaches to reduce HIV/STD risk in this population. We describe the development and implementation of the Multidimensional Family Therapy HIV/STD risk-reduction intervention (MDFT-HIV/STD) in terms of using multifamily groups and their integration in standard MDFT and also offers a clinical vignette. The potential significance of this empirically based intervention development work is high; MDFT-HIV/STD is the first model to address largely unmet HIV/STD prevention and sexual health needs of substance abusing juvenile offenders within the context of a family-oriented evidence-based intervention.     

Fostering Client Creativity in Family Therapy: A Process Research Study

Creativity has been shown to enhance problem solving, and to increase flexibility and adaptability—qualities associated with positive therapeutic outcomes. Literature related to therapist and/or client creativity is primarily anecdotal. Empirical literature addressing how therapists can facilitate the creativity of their clients in family therapy is scarce. In this study, the researchers used process methodology to code the behavior of therapists and clients in 31 videotaped family therapy sessions. Results show a significant positive correlation between interventions that induce positive affect and the creative client behaviors of optimism and playfulness.     

Advances in Latino Family Research: Cultural Adaptations of Evidence-Based Interventions

The stark contrast between frequent calls for research and practice that are applicable across a broad spectrum of cultural and ethnically diverse groups and the dearth of empirical knowledge about Latino families provided the impetus for this special issue on advances in Latino family research. A focus on empirically based practice frames the issue, focusing specifically on how concepts (expressed emotion, parenting style) can be used within interventions, how Latino parents perceive efforts to deliver evidence-based interventions, and how pilot projects that delivered culturally adapted interventions in three separate cities impacted family functioning. In all, the introduction highlights the complexities for researchers in meeting the needs of the field to ensure that effective interventions are applicable across cultural groups. Meeting the challenges is important to address the need of the growing Latino population. Advances in intervention research with ethnic minorities also stand to contribute to the advancement of intervention research broadly. This special issue provides examples of efforts that are underway to better understand what treatments work for Latino families, provided by whom, for what specific problems, and in which specific circumstances, paving the way to begin attempting to answer a challenge posed more than 40 years ago by Gordon Paul.     

Comments on Research in Family Therapy

This comment is submitted with the intent of stimulating some exchange between researchers. Although I chose the Woodward et al. study as a vehicle for my statement, I might easily have chosen examples outside the family therapy area.     

Ethical Considerations in Family Therapy Research

In this article, significant ethical issues that arise in the conduct of family therapy research are considered and four major areas are emphasized: (a) the researcher's responsibility to protect the rights of research participants, (b) confidentiality and informed consent, (c) the researcher's values, and (d) methodology. In each area, parallels are drawn between the ethical issues facing family clinicians and those facing family researchers.     

Family-Based Therapy for Adolescent Drug Abuse: Knowns and Unknowns

Family-based therapy is one of the most thoroughly studied treatments for adolescent drug abuse. Considerable empirical support exists for the efficacy of family-based therapy in curtailing adolescent drug use and cooccurring behavior problems. This article extends knowledge of the effects of family-based therapy for adolescent drug abuse by reviewing 16 controlled trials and 4 therapy process studies from a treatment development perspective. We articulate knowns and unknowns regarding the outcomes of treatment as well as the components, processes, mechanisms, moderators, and boundaries of effective family-based therapy for adolescent drug abuse. The review highlights areas of progress and future research needs within the specialty of family-based therapy for adolescent drug abuse.     

Likeness: A Hidden Ingredient in Family Therapy

The purpose of this paper is to show how one can progress from a validated theoretical model to its practical application in family therapy. The model applied in this case is the Likeness Continuum consisting of six degrees of Likeness: symbiosis, sameness, similarity, differentness, oppositeness, and alienation. A formal Task to evaluate this model in family therapy is attached to provide a basis for the evaluation of this model in the laboratory and in the therapy office.     

Family Therapy in France: A Brief Overview

The major issues in contemporary family therapy in France are described: Difficult beginnings, the practice of family therapy today, training and professionalisation, organization for family therapy, journals and publishing, and perspectives for family therapy in France.A psychiatrist, Head of Hospital Psychiatric and Mental Health Center near Paris (Ville Evrard. France 93330) and a family therapist     

A Family Therapy Narrative

The evolution of the field of family therapy since its inception in the 1950s is traced in this article. Major contributory forces as well as key pioneers in the first generation and leaders in successive generations are highlighted. This is followed by an elucidation of the conceptual foundations and basic principles undergirding almost all of the main theoretical schools. Expansion in this now vast field is underscored through attention to the proliferation of the number of books and journals addressing family therapy/psychology topics as well as mention of the internationalization of the field. A typology of extant theoretical models is also presented. The article closes with a discussion of contemporary issues and trends.     

The Inclusion of Fathers In Family Therapy: A Research Based Perspective

This paper summarizes the results of research on the role of fathers in families and family therapy with particular reference to preparation for fatherhood, father involvement in family life as a protective factor, fathers' deviant behaviour as a risk factor, fathers' communication and coping styles, fatherhood and different types of marriages, and the effects of the workplace on fathers' behaviour within the family. Available research suggests that, with respect to problem formation, the behaviour of fathers may serve as either a risk factor or as a protective factor. With respect to problem resolution, fathers may be a powerful therapeutic resource or seriously compromise effectiveness of family therapy. The implications of research for clinical practice are discussed.     

Searching for Family Therapy in the Rockies: Family Therapists Meet A Paleontologist

Family therapists use concepts germane to other academic disciplines. We recount four notions--context, explanatory metaphors, language conventions, and persistently refining knowledge--that family therapists and paleontologists each utilize. Revisiting family therapy's foundational concepts through the lens of another discipline reminds us of our theoretical beginnings, highlights those professional adaptations that we have made over the years, and offers us an opportunity to reinvigorate and expand our central organizing principles.     

Dropping Out of Marriage and Family Therapy: A Critical Review of Research

The lack of attention given to research on the premature termination by clients in marriage and family therapy is evident in research reviews of the dropout phenomenon in psychotherapy. This article is an attempt to fill that void. The research literature on dropping out of family therapy is reviewed and organized. Studies in this area tend to focus on four kinds of variables: client characteristics, therapist characteristics, therapy process variables, and interventions. Stable findings in each of these areas are pointed out. Both limitations and recommendations for future research are discussed.