Healing the Wounds of the Mahantdori

The magnitude of the Mahantdori, or Cambodian holocaust, must be understood by therapists who are trying to help the survivors deal with the illness and injuries that are a product of this destruction. This paper presents an overview of the events that have come to be known as the Mahantdori and a model for treating the multiple levels of trauma with which the Cambodian family must deal. The Contextual Model of Family Therapy, as described by Ivan Borzormenyi-Nagy, is used as the structure for helping to rebuild trust within the family while at the same time treating the injuries of the individual family members. The changing role of Cambodian women and their need to form new support groups because of their devastating loss of family are described.     

Comparisons of second-generation holocaust survivors, immigrants, and nonimmigrants on measures of mental health

To determine whether a "children-of-holocaust-survivors syndrome" could more parsimoniously be explained as an "immigration effect," we performed a comparative study on a sample of 25 children of holocaust survivors, 25 children of immigrants, and 25 children of American-born parents. Subjects were matched on age and educational level and were assessed with four measures of mental health. Contrary to the findings of some researchers whose data supported such a syndrome, our data indicate no significant differences between children of holocaust survivors and the children of other immigrants. These data are suggestive of an immigration effect that is common to the children of immigrants and not limited to the children of holocaust survivors, rather than a survivors syndrome. The children of American-born parents showed greater alienation, less religiosity, and a tendency toward feelings of less guilt than the other two groups. Our data underscore the need to control immigrant status in multiple samples and studies before definitive conclusions can be drawn in this area.     

Recent and emerging trends in marital and family therapy regulation

The number of states in the United States that formally credential marital and family therapists has tripled to 31 during the last decade. This paper reviews and compares the basic licensure and certification requirements in these states, and explores a number of broad issues currently confronting the field of marital and family therapy regulation. Several recommendations for improving the quality of MFT regulation are also provided.president of the Association of Marital and Family Therapy Regulatory Boards.     

Is identifying with a historically victimized group good or bad for your health? Transgenerational post‐traumatic stress and collective victimization

An abundance of evidence suggests that the consequences of collective ingroup victimization can traverse generations, even among group members who are not direct descendants of victims. It nevertheless remains unclear why only some group members experience vicarious victimization. To examine the role of collective identification in the transmission of trauma across generations, we surveyed members of a Jewish community—including descendants of holocaust survivors and others who were not descendants of the holocaust survivors. Among non‐descendants, Jewish identification was negatively associated with symptoms of post‐traumatic stress disorder (PTSD). In contrast, among descendants, Jewish identification was positively associated with PTSD symptoms. Further, familial willingness to discuss the holocaust mediated the relationship between identification and PTSD symptoms. Additional analyses confirmed that these effects were specific to holocaust‐related PTSD symptoms and not general anxiety or depression. These findings suggest that collective identity may both buffer and enhance the effects of collective victimization on mental health. Copyright © 2011 John Wiley & Sons, Ltd.     

Dialogue and Dominance in Couple Therapy for Depression: Exploring Therapists’ Responses in Creating Collaborative Moments

Previous investigations have found specific communication patterns in couples dealing with depression, specifically when depression concurs with conjugal conflicts. The presence of these patterns can reflect couples’ difficulties in engaging in collaborative communication during their sessions, posing a real challenge for therapists. This exploratory study uses a dialogical approach to examine issues of dominance and type of dialogue in two couples who differed in terms of their levels of dyadic adjustment. The therapists’ reactions were explored in order to detect the kinds of responses that were most effective at engendering a collaborative attitude in therapy sessions. The method used to analyze the dialogue was Dialogical Investigations of Happenings of Change (DIHC). Results on dominance indicated that the degree of quantitative and semantic dominance displayed by a different member of the couple in each case was illustrative of their relational dynamics, while in both cases interactional dominance was exercised by the therapists. Results on dialogue revealed that dialogic dialogue might help to coconstruct new shared meanings of depression. The findings indicated that certain responses by therapists as part of the dialogue could be useful in bringing about a reduction in hostility between the members of a couple, provided that the responses are maintained over the course of the session. Some research and clinical implications that emerge from the results are discussed.     

Treating holocaust survivors

Contemporary Family Therapy - There has been a substantial body of literature on the political, economic and emotional legacy of the holocaust on the victims who survived and their families. It has...     

The protective role of compassion satisfaction for therapists who work with sexual violence survivors: an application of the broaden-and-build theory of positive emotions

Therapists who work with trauma survivors, such as survivors of sexual violence, can experience compassion satisfaction while experiencing negative effects of trauma work, such as secondary traumatic stress. We examined whether the negative effects of secondary traumatic stress on therapist adjustment would be buffered by compassion satisfaction and whether the broaden-and-build theory of positive emotions could be applied to examine the factors (positive emotions and positive reframing) that relate to compassion satisfaction. Sixty-one therapists who work with sexual violence survivors completed measures of secondary traumatic stress, compassion satisfaction, adjustment, positive emotions and positive reframing. Hierarchical multiple regression analyses found that compassion satisfaction buffered the negative impact of secondary traumatic stress on therapist adjustment when adjustment was conceptualised as anxiety. Using non-parametric bootstrapping, we found that the relationship between greater positive emotions and greater compassion satisfaction was partially mediated by positive reframing. The findings indicate that compassion satisfaction is likely to be helpful in ameliorating the negative effects of secondary traumatic stress on anxiety in therapists who work with sexual violence survivors and that the broaden-and-build theory of positive emotions may provide a strong theoretical basis for the further examination of compassion satisfaction in trauma therapists.     

Therapeutic implications of counselling psychologists’ responses to client trauma: An interpretative phenomenological analysis

The past two decades have seen a surge of interest in the impact of working with trauma survivors on therapists’ psychological well-being. Existing literature assumes that therapists’ strong subjective responses to traumatic material adversely influence the therapeutic process. However, this has not yet been directly researched. Nine counselling psychologists were interviewed regarding the clinical impact of their responses to the disclosure of traumatic material. Interpretative Phenomenological Analysis showed that significant challenges are experienced in the use of self in therapy with trauma survivors, including making sense of horrific human actions, negotiating complex interpersonal dynamics and responding to ethical dilemmas in therapy. Results emphasised the importance that therapists attached to the development of their therapeutic use of self in therapy with trauma survivors, the value of learning from others and reaching a place of acceptance and hope when working with trauma survivors. Finally, specific training and development implications are proposed.     

Promiscuity in the practice of family therapy

Family therapy has continually confronted choices between polarized positions, each one taken up with zeal because it solved an old dilemma but eventually encountering its own limitations. In this article I suggest that we have evolved to a point where, instead of deciding which is better, we can focus on how to use theories, models and techniques as fluid and flexible resources for action in the therapeutic conversation. Doing so focuses our attention on how we can move in and out of various positions, including those that simplify issues and those that embrace complexity. In addition, our attention is drawn to the ways in which we can make choices between following a model as opposed to engaging in spontaneous dialogue. This promiscuous stance can help trainers and therapists answer questions concerning how we make decisions in therapy. Such promiscuity also positions us to confront our images and expectations of what it means to be a professional.     

Coping styles of (first- and second-generation) holocaust survivors

The eight coping styles proposed by Plutchik (Development of a scale for the measurement of coping styles: a preliminary report, Einstein College of Medicine, 1985) were investigated in small groups of holocaust survivors and their grown-up sons and daughters.It was found that fathers reported using mainly Blame and Mapping. Mothers used mainly Minimization, seeking Succorance, Replacement and Substitution.Sons reported using mostly Minimization, Replacement, Mapping and Reversal.It was further found that fathers' use of coping styles was on the whole most similar to daughters' use. The same is true of mothers, the greatest similarity noticed being between sons and daughters. Fathers' and mothers' use of coping styles was least similar.     

Hypotheses are dialogues: sharing hypotheses with clients

The use of systemic hypotheses in therapy has been criticized on the ground that it promotes the expert position of the therapist and tends to underplay the role of the client in the therapeutic process. In this article, we propose to view the systemic hypothesis as a collaborative action, involving the dialogue between therapists and clients. This interactive hypothesis is created by the very interaction of all participants in the therapeutic dialogue, and as such it may be considered a dialogue in itself. The article articulates a way of hypothesizing that is consistent with both systemic and dialogic premises, and presents some examples of the process in action.     

Media Coverage of Child Sexual Abuse: An Opportunity for Family Therapists to Help Families and Communities

The recent media coverage of child sexual abuse charges involving priests is likely to trigger various needs among the public for professional services. Family therapists should prepare to respond effectively to the high anxiety that these media stories trigger. Family therapists with expertise in human sexuality should use such reports to promote a fuller understanding of all aspects of sexuality for individuals and families. Professionals can integrate much needed aspects of sexuality education in dealing with the mass media, in crisis intervention for persons at risk, and in therapy that centers on child or adult experiences of sexual abuse.     

Reflections on Family Therapy in Australia

Family therapy in Australia has been influenced by ideas mostly from North America and Europe. However Australian family therapists have also made their own significant contributions to theory and practice. The vastness of the continent combined with a relatively small population has presented challenges with respect to the formation of a national association and for many years, the Australian Journal of Family Therapy (later the Australian and New Zealand Journal of Family Therapy Board acted as de facto national voice for the discipline. The Australian Association of Family Therapy was formed as recently as 2011. It has a total of over 1,000 members and is the sole organisation representing family therapy and family therapists in Australia. Clinical membership is achieved via successful completion of a 2-year sequence of study in family therapy followed by 50 hours of supervision (or its equivalent). Family Therapy training is mostly delivered in the four most populated states in Australia at both University level and through private organisations registered to provide training at government approved levels. La Trobe University (through the Bouverie Centre), Swinburne University (through the Williams Road Family Therapy Centre) and the University of New South Wales currently provide training leading to specialist qualification in family therapy. A number of other private institutions also provide recognised family therapy training. To date, family therapists and couple therapists in Australia have not in the main shared common platforms such as conferences, training and professional journals. Narrative therapy has also remained somewhat detached from “mainstream” family therapy. Family therapy qualifications are often valued by prospective employers even when duty statements are focused on the more traditional skills of professionals such as psychologists or social workers. Researching family therapy outcomes remains challenging. But although there is increasing practiced-based evidence of the efficacy of family therapy, Australian family therapists as a group are yet to concentrate their efforts on convincing funding bodies of its usefulness. At the same time, via the teaching and promotion of family sensitive practices, systemic ideas are being increasingly incorporated within areas of mental health, disability, alcohol and drug dependency, and within a range of health and welfare areas that impact not just on the individuals but on those close to them.     

The Added Value of Studying Embodied Responses in Couple Therapy Research: A Case Study

This article reports on the added value of embodied responses identified through sympathetic nervous system (SNS) activity in couple therapy research. It focuses on moments of change and the timing of therapeutic interventions or therapeutic moves in a couple therapy session. The data for this single‐case study comprise couple therapy process videotapes recorded in a multi‐camera setting, and measurements of participants’ SNS activity. The voluntary participants were a marital couple in their late thirties and two middle‐aged male psychotherapists. The division into topic segments showed how the key issue of seeking help, which was found to comprise three separate components, was repeatedly dealt with in the session. SNS activity showed different degrees of synchronization between the couple, between the therapists, and between the couple and therapists during the dialogue pertaining to these three components. The issue of timing emerged as a complex, even ambivalent, phenomenon. Arousal in the therapists was in line with their therapeutic activity, whereas in the clients it was more anticipatory. The approach used here rendered visible some of the intensity that therapeutic dialogue can generate when dealing with issues of relationship change in the couple context and showed how this intensity can be dialogically regulated in the therapeutic system.     

Change: How do we recognize it?

The paper seeks to examine the working assumptions that guide us as therapists engaged in the attempt to facilitate change in families. It summarizes a piece of preliminary research based on the responses of a group of therapists working in different agencies. A questionnaire on change was developed and given to the therapists followed by a group discussion.
The results suggest that therapy teams, and families, have common sense ideas about:

• the beginning, and end of a period of change;

• types of change—those falling into four categories; of behavioural, structural, communication and experiential.

Our results suggest that difficulties in therapy may be associated with a failure amongst the therapists in a team to negotiate their mutual assumptions about change. In addition the process of therapeutic change is seen as involving a negotiation between the family and the therapists about what will count as change.
The data were gathered from a group of therapists attending a local meeting of the Association for Family Therapy in Plymouth.     

Secondary traumatic stress and adjustment in therapists who work with sexual violence survivors: the moderating role of posttraumatic growth

ABSTRACT

Due to their secondary exposure to the traumatic events disclosed by clients, therapists who work with sexual violence survivors are at risk of experiencing secondary traumatic stress. We examined whether the negative effects of secondary traumatic stress on therapist adjustment would be buffered by posttraumatic growth. Sixty-one therapists who work with sexual violence survivors completed measures of secondary traumatic stress, posttraumatic growth and a range of adjustment indicators. Hierarchical multiple regression analyses demonstrated that posttraumatic growth moderated the negative impact of secondary traumatic stress on therapist depression, anxiety, personal meaning and satisfaction with life. Posttraumatic growth sustained positive affect through a direct effects model only. This study provides support for the protective role of posttraumatic growth in adjustment to secondary traumatic stress.     

The Impact of Sexual Assault on College Students’ Daily Occupations: A Phenomenological Approach

Abstract

Sexual assault is associated with a high degree of Posttraumatic Stress Disorder (PTSD) severity. Three in ten survivors of campus sexual assault develop PTSD over their lifetime. Occupational therapists treat veterans with PTSD, but limited research exists addressing college student survivors of sexual assault and occupational therapy. A phenomenological approach was used to understand meanings of sexual assault for college student survivors. Semi-structured interviews yielded rich data and themes of disruption and reduced quality of life. The author concludes there is potential for occupational therapists to play a collaborative role on college campuses.     

Stress and coping in the practice of family therapy: a British survey

A sample of 171 members of the Association for Family Therapy (UK) was surveyed and data obtained on their general level of experienced stress, the sources and levels of experienced stresses they encountered in their practica, and the professional and private coping strategies they used to mitigate the effects of these stressors. The results indicate that stress can be experienced in all practice contexts, with important factors in its overall configuration being personal/professional worth and agency expectation. Family therapists appear to prefer coping strategies of a more social nature and there is an ambivalent attitude towards'therapy for therapists'.     

Family Survivors of Homicide: I. Symptoms,Syndromes, and Reaction Patterns

As more and more mental health clinicians become involved in the criminal justice system, family therapists will see increasing numbers of crime victims in their caseloads, and some of these families will have lost loved ones to murder. Part I of this two-part article describes the common and atypical symptoms, syndromes, and reaction patterns shown by families who have experienced the murder of a loved one. Part II will present a practical model for treating family survivors of homicide that incorporates cognitive-behavioral, psychodynamic, family systems, and existential components. Throughout, the emphasis is on therapists being equipped with a sufficiently broad range of clinical tools to treat these survivors flexibly, effectively, competently, and compassionately.