Medical family therapy: an emerging arena for family therapy

This paper describes an important recent development in American family therapy. Medical family therapy uses a biopsychosocial systems model to work with families who have a member with a chronic illness or disability. The authors maintain that family therapy has tended to embrace the mind–body split and to view itself too narrowly as a mental health specialty. Medical family therapists work collaboratively with physicians and other health professionals to help families achieve a sense of agency and communion in facing some of the greatest challenges that life brings.     

Challenges of an outcome-based perspective for marriage and family therapy education

Marriage and family therapy (MFT) and marriage and family therapy education (MFTE) have undergone many changes during the short history of MFT. This article describes the current trends and controversies in MFTE, including shifts toward outcome-based education (OBE). We present recommendations for MFTE, including the move toward OBE, the development of core competencies of MFT, attention to interdisciplinary issues, and recognition of the need for both foundational education and encouragement of trainees' unique styles and approaches.     

The impact of attributions in marriage: a longitudinal analysis

In this study, we investigate the longitudinal relation between attributions for relationship events and marital satisfaction. Thirty-four couples were assessed at two points separated by approximately 12 months. Causal and responsibility attributions for marital difficulties and negative spouse behaviors were strongly related to concurrent marital satisfaction. For wives, later marital satisfaction was predicted by both causal and responsibility attributions after the effects of earlier satisfaction were removed. For husbands, attributions did not predict later marital satisfaction. Marital satisfaction did not predict later attributions for either husbands or wives. Marital satisfaction and the two types of attributions were related to concurrent unrealistic relationship expectations, but these expectations did not predict later marital satisfaction. The results are discussed in terms of a possible causal relation between attributions and marital satisfaction.     

Sharing a multicultural course design for a marriage and family therapy programme: one perspective

The marriage and family therapy (MFT) field has made tremendous progress in acknowledging the importance of multicultural training. Nevertheless, multiculturally committed MFT trainers still struggle with issues of multicultural course design and delivery. In a subject so controversial and which requires a great deal of experience and skills to teach, little has been done in terms of sharing different multicultural course designs and working towards their implementation in MFT programmes. This paper presents a prototype curriculum of an introductory course in multiculturism in counselling for marriage and family therapy students with the overall goal of making trainees more multiculturally aware. It includes a few examples of strategies designed to aid the continuing infusion of multiculturalism into MFT programmes.     

Selecting marriage and family therapy program applicants: One approach

Abstract

Brigham Young University uses a unique approach to select applicants to the master's and doctoral programs in marriage and family therapy. Traditional methods are augmented by the use of a highly reliable interaction-analysis instrument, a microcomputer, and a large computer frame to analyze the verbal interaction of applicants who conduct therapy with coached couples. Interactions of an accepted and a rejected applicant are compared.     

Graduate trends for one marriage and family therapy program in an interdisciplinary setting

This research compared trends from 1981 to 1993 in several mental health professional training programs at the University of Houston Clear Lake, surveying graduates from three professional mental health master's programs—clinical psychology, school psychology, and family therapy—with the goal of identifying trends in the status of their professional credentialing and current employment. Four mental health groups have attained licensure since a 1981 survey, resulting in graduates now seeking professional licenses and perform psychotherapy more exclusively than other mental health activities. Interdisciplinary training has become increasingly important due to the introduction of managed care and other insurance regulating entities.     

Alcoholism treatment and marriage and family therapists: An empirical study

This article reports on results of a mail questionnaire study conducted among 257 members of the American Association for Marriage and Family Therapy (132 respondents, response rate of 51%) on their attitudes toward alcoholism issues (acceptance of alcoholism as a disease, treatment philosophies used with clients and/or families, and acceptance and use of Alcoholics Anonymous as a resource). Results indicated that 69% of respondents (as compared with 42% formerly) considered alcoholism a disease after MFT education. A combination of individual, family therapy, and AA (81.1%); family therapy (66.7%); and AA only (60.6%) were most often used. Controlled use of alcohol by clients in treatment was believed to be unethical by 43.2%, legal by 39.4% and ineffective by 54.5%.     

Defining a family heritage and a new relationship identity: two central tasks in the making of a marriage

The roles of origin family environmental characteristics and couple consensus-building process within the development of marital relationships were examined prospectively in 16 premarital couples. Three important findings emerged. First, significant correlations were found between dimensions of origin family environment and the reported level of satisfaction within the couple's current relationship. Second, measures of the couple's ability to reach consensus concerning important interpersonal relationships appeared to be important mediators of the association between origin family environment and current relationship satisfaction. Third, important gender differences emerged that replicate and extend prior findings that portray women in the role of "relationship specialist" within their marriages. As a group, these findings were best explained by a developmental model of early marriage that envisions the young couple as facing two entwined tasks: to define both their family heritage and their new relationship identity. Overall, the importance of examining family-of-origin characteristics and consensus-building process as critical determinants of the fate of intimate relationships received strong support. The gender differences found in the literature reviewed, as well as the results of this study, have largely been overlooked by the theory and practice of family therapy. Efforts on both the research and theory construction fronts are needed to increase our understanding of the mechanisms whereby prior family experience is brought forward into current intimate relationships.     

Expressed attitudes of adolescents toward marriage and family life

In the U.S., modifications in family structure and in attitudes concerning marriage and family life have been numerous. Areas such as sexual behavior and alternative living arrangements have become highly varied and nontraditional compared to past generations. This study examined the attitudes of adolescents toward aspects of marriage and family life. The majority of adolescents expressed negative attitudes toward divorce and viewed marriage as a lifelong commitment. While only about a third of the adolescents expressed positive attitudes toward premarital sex, a majority indicated they would engage in sexual intercourse before marriage, or already have. Interestingly, about half of the adolescents held positive attitudes toward cohabitation. Lastly, the adolescents demonstrated a growing acceptance of premarital counseling and psychoeducational interventions regarding marriage and family life.     

Changing family formation in Nepal: marriage, cohabitation and first sexual intercourse

CONTEXT: In Nepal, marriage occurs at a relatively young age and arranged weddings are widespread. However, recent changes in the family formation process and the timing of first sexual intercourse suggest that a transformation may be under way. METHODS: Data on marriage, cohabitation and first sexual intercourse from the 2001 Nepalese Demographic and Health Survey were used to describe the family formation process. The sequence of these events and the intervals between them were explored for currently married men and women. Hazard models were used to identify factors associated with behavioral changes over time. RESULTS: The average age at marriage among women married before age 20 increased from 13.7 years for those born in 1952-1956 to 15.6 years for those born in 1977-1981, while remaining relatively stable for men married before age 25 (17.3 years for the 1942-1946 birth cohort to 17.7 for the 1972-1976 birth cohort). After individual and couple characteristics were controlled for, younger age at interview was associated with greater odds of simultaneous marriage and cohabitation for both genders (odds ratios, 1.3-1.7). Younger age at interview was also associated with premarital sex among men--those aged 39 or younger had significantly higher risks than older men of having had premarital sex, with odds ratios rising from 1.6 among those aged 35-39 to 1.8 among those aged 15-24. CONCLUSIONS: It is important not only to promote education as a means of delaying marriage and childbearing, but also to implement programs and services that prevent reproductive health problems for young married couples.     

Beyond a single standard: levels of evidence approach for evaluating marriage and family therapy research and practice

Randomized clinical trial (RCT) research has come to dominate the research landscape of marriage and family therapy (MFT). Despite becoming the ‘gold standard’ for evaluating clinical research and clinical practices, there is a growing debate regarding the reliance on RCTs as the primary basis for evaluating clinical intervention in MFT. Given the natural diversity of clients, settings and clinical problems faced by practitioners and the relational and recursive interactional process of MFT, one of the major challenges for the field of MFT will be to come to grips with the research–practice gap by moving beyond a single methodological standard through adopting a ‘levels of evidence’ approach as a framework that promotes diverse research methods, different methodological criteria (depending on the method), and evaluation based on the accumulated type of evidence needed to answer a specific policy, clinical practice choice, or within a model clinical decision.     

Serial learning: A multilevel access analysis

In Experiment I the lists were 36 and 48 unrelated words. Each was divided into successive groups of four words and learned to a perfect criterion. In Experiment II the lists were made up of six categorical groups of five exemplars each. Degree of learning was varied. In both experiments serial anticipation learning was followed by ordinary free recall and free recall under speed stress. Analyses of acquisition and of both recall tests indicate that group access is a marked function of serial position but that within-group retrieval given group access is constant over serial position. It is argued that serial learning proceeds simultaneously at different levels of representation.     

Serial homicide: an investigation of behavioural consistency

To examine if serial homicide offenders are consistent across their crimes, a model was developed empirically that could be used to distinguish between crimes that were instrumental and those that were expressive. The first known three offences in each series of 69 US serial homicides committed by 23 offenders, were examined and the instrumental and expressive themes determined. Three models were then explored that test for consistency across these themes. The most liberal model was found to classify all of the offences effectively and to reveal complete consistency across the three crimes for all offenders. The implications of these results for offender profiling and further study of serial homicide are discussed. Copyright © 2005 John Wiley & Sons, Ltd.     

Affect is a form of cognition: A neurobiological analysis

In this paper, we suggest that affect meets the traditional definition of "cognition" such that the affect-cognition distinction is phenomenological, rather than ontological. We review how the affect-cognition distinction is not respected in the human brain, and discuss the neural mechanisms by which affect influences sensory processing. As a result of this sensory modulation, affect performs several basic "cognitive" functions. Affect appears to be necessary for normal conscious experience, language fluency, and memory. Finally, we suggest that understanding the differences between affect and cognition will require systematic study of how the phenomenological distinction characterising the two comes about, and why such a distinction is functional.     

Dynamics of psychoanalytic supervision: a heuristic model

This paper presents a heuristic model for the dynamics of psychoanalytic supervision. It is not a manual for how to perform supervision, but a model for how to identify and think about the complex elements and forces influencing the supervisory process. The point of departure is that psychoanalysis is a composite craft in which seemingly contrary elements like strict rules and creative intuitions have their place and interact. Several aspects of supervision are discussed: aims, learning processes, teaching methods, relationship, emotional atmosphere and evaluation. Competence is given a pivotal place in the model. The main feature of the model is that these aspects of supervision are all seen as suspended in a field of dynamic tensions between phenomena in real or apparent opposition. One example of this is the tension in the supervisory relationship between supervisor as instructor acting as an authority for the candidate whilst being a mentor fostering autonomy in the candidate. It is argued that related kinds of dynamics characterize several aspects of psychoanalytic supervision and that these tensions are inherent in analytic work. In conclusion a key word picture of the model is presented.