An Ecological Perspective: Therapist Practices with Children who Experienced Abuse and Trauma

This qualitative study explores experiences of psychotherapists working in public settings with children who experienced abuse and trauma. The study sought to investigate and understand factors which intruded upon and or supported the capacity for psychotherapists in a community clinic to cognitively process and understand supportive and constraining aspects of the professional context. An important focus was the organisational context of psychotherapists. Nine psychotherapists were interviewed to gain an understanding of their experiences with and perceptions of the needs of children including factors considered important in therapy, the influences of their organisational context, and challenges and rewards of the work. An Interpretative Phenomenological Analysis of interview data revealed three broad themes identified as relational, organisational, and systemic. An ecological metaphor was used to conceptualise these themes as they related to psychotherapists and the children with whom they worked. The findings demonstrated the importance of the psychotherapist's organisational context on how they experienced their work. This study also considered the need to conceptualise therapy with children who have experienced trauma within the interaction of the child and therapist's relational, organisational, and systems context.     

Integration: A coming of age

Integration is one of the most prevalent contemporary themes in the field of family therapy. This discussion proposes a process-based model of integration which transcends theoretical content. A brief review of integrative efforts in the field of marriage and family therapy is followed by an exploration of issues related to theoretical content. A model for understanding the personal process of integration is developed which articulates a five stage process of integration. Finally, after a brief character development to illustrate the different stages, some initial implications for a process-based model of integration are explored.David J. Moultrup, MSW, LICSW, is in private practice in Arlington, Massachusetts.     

Ethical Ambiguities in Participatory Action Research With Unauthorized Migrants

There is increased recognition of the importance of well-designed scholarship on how immigration status and policies impact migrants in the United States, including those who are unauthorized. Some researchers have looked to community-based and participatory methods to develop trust, place migrants’ voices at the forefront, and engage collaboratively in using research as a tool for social change. This article reviews three ethical ambiguities that emerged in the process of a series of participatory action research (PAR) projects with migrants in the United States, many of whom were unauthorized. Specifically, three themes are discussed: (a) the tension between the human desire to respond to injustices, and the challenges of doing so in ways that recognize one’s privilege and power as an outsider and supports the migrants’ agency and autonomy; (b) the complex definition, explanation, and dimensions of “risk”; and (c) the complexity of using a methodology (PAR) that prioritizes participants’ collective identity and community in the context of regulations that are designed primarily to protect individuals.     

Witnessing stories: Definitional Ceremonies in Narrative Therapy with adults who stutter

BackgroundNarrative therapy (White & Epston, 1990) was developed as an approach to counselling, as a response to the power relations that influence people's lives. Its use with people who stutter has been documented. A basic tenet of narrative therapy is that the dominant problem-saturated narrative is challenged by externalizing the problem, in due course facilitating development of an alternative narrative. Within this process, the definitional ceremony involving outsider witnesses is a key procedure used to influence change.AimsThis paper describes definitional ceremonies, and their application within a narrative approach to therapy for stuttering. The analysis of a specific definitional ceremony is presented, leading to an exploration of identity as a public and social achievement.MethodsA definitional ceremony involving a woman who stutters and family members was recorded and analysed using two methods: interpretative phenomenological analysis and Heideggerian hermeneutic phenomenological analysis. Details of the clinical application of definitional ceremonies with this client are described.Results and conclusionsResults from both methods of analysis were found to be similar. Notable results include the fact that the stuttering per se was not presented as the problem; rather, the impact of stuttering, especially the experience of bullying, was a dominant theme. This paper shows how definitional ceremonies can open opportunities for clients to present themselves in a preferred way, forming the basis for a new story and revised identity. Emerging themes can be identified for reflection and discussion with the client for therapeutic benefit.Educational objectives: (1) to describe and explain to readers the process of narrative therapy, with special attention to the use of definitional ceremonies; (2) to provide detail regarding the clinical processes involved with a specific definitional ceremony with one client; (3) to have the reader appreciate the specific importance of involving outsider witnesses in the therapy process; (4) to discuss the outcomes of the use of this particular definitional ceremony.     

Constructing bridges and systemic connections: In brief dynamic therapy

The author outlines how the conceptual framework which underpins cyclical psychodynamics, a branch of relational psychoanalysis, provides an opportunity for a coherent integration of constructivist CBT principles and techniques and family systems theory within a model of brief dynamic therapy. Drawing upon Wachtel’s articulation of a more flexible notion of the internal world and one in which current interpersonal patterns are seen to shape the psyche and internal conflicts, the author goes on to identify ways in which attending to a client’s behaviour and the ways in which affective experience is expressed interpersonally can open the way to an integration of therapeutic features from constructivist CBT and family systems theory. The contribution that coaching a client in the ways in which they behave interpersonally in the context of both family and workplace relationships can make to therapeutic effectiveness is explored. These themes are illustrated with a case study.     

American Indian Researcher Perspectives on Qualitative Inquiry About and Within American Indian Communities

It is presumed that Indigenous researchers are optimally positioned to conduct research about or within their own or other Indigenous communities. However, these researchers may still experience challenges, barriers, and distressing events that are important to identify. Qualitative inquiry may be a particularly vulnerable context for Indigenous researchers given the nature of data collection methods and an emphasis on researcher–participant relationships. This paper details the personal reflections of two American Indian (AI) researchers who carried out qualitative research focused on AI issues and/or communities. The first project examined undergraduate students’ opinions of the use of AI imagery in the form of a race‐based university mascot. The second was a study of the mental health needs of AI youth and families in an urban community. Several themes characterized both of their experiences and might be generalizable to others working in these contexts: (a) coping with racism and microaggressions; (b) the role and impact of identity politics; (c) community insider/outsider tension; and (d) managing personal distress associated with the research topics and process. These themes are discussed to illuminate ways that Indigenous researchers, engaged in research on Indigenous topics and/or with Indigenous communities, are challenged and affected by their work.     

Discovering forgiveness through empathy: implications for couple and family therapy

This article explores the concept of forgiveness in the context of couple and family therapy. Forgiveness is described as a complex psychological and relational process that is more a discovery via understanding and empathy than an act of will. Empathy is related to emotional intelligence, and the developmental and relational benefits of both are discussed. A rationale for viewing forgiveness in a contextual (family of origin), historical and relational attachment paradigm is offered. Relevant clinical cases illustrate the process of forgiveness as discovery in the context of an empathic relational environment where ambivalence is anticipated and respected.     

Family therapy for childhood depression: researching significant moments

This paper is a qualitative family therapy process study which is part of a larger European-based outcome study comparing family therapy to child psychotherapy plus parent support for depressed children and their families. The family therapists and two clinical supervisors from the original study formed themselves into a research team to study the process of therapy with twelve families. Therapists selected the significant moments from fifty-nine sessions, and were then interviewed by the research team using a standard protocol to investigate the therapists' own thinking about the significant moments. Applying a thematic analysis, the significant moments were clustered into eleven themes. The paper discusses the rationale for this model of research, which is well suited for clinical teams, and the application of the themes to therapeutic work with depressed children and their families.     

Empowerment Themes for Couples Therapy

SUMMARY

Empowerment is defined as a process occurring in a relational context in which all participants in the relationship interact in a manner which establishes connection and strengthens each person's sense of self worth and personal power. The purpose of the article is to apply specific themes of empowerment for couples therapy. Six major themes are presented: (1) taking and being in charge of one's self; (2) acknowledging and valuing difference and diversity; (3) power in relationship; (4) choices and options; (5) necessity of skills in relating to the wider societal context; and (6) taking action. Techniques for working with couples from an empowerment perspective are also offered.     

Tigers are something else: A case for family play

This paper is an attempt to bridge the two worlds of family therapy and filial play therapy, introducing the complementary idea of play in therapy. Family play therapy challenges the idea that play is only useful in the treatment of children. Clinical examples are given and uses of play are discussed, including evaluation, play as a therapeutic tool, and the development of themes. The authors believe that therapists who are willing to be playful offer their clients a new world of therapeutic experiences.     

The family therapy journals in 2001: a thematic review

This article reviews the principal English–language (including British) family therapy journals for the year 2001. Articles are clustered around various common themes which include marital therapy and cultural competency. There is also a discernible interest in working with populations that have received less attention from family therapists such as substance misusers. Within this literature there is also a trend to 'import' ideas and methods from other therapeutic traditions. Important research papers are noted from within these categories, rather than having a separate section. As this is the fifth in a series of reviews, a 'look back' at trends within the family therapy literature concludes the paper.     

Engaging refugee families in therapy: exploring the benefits of including referring professionals in first family interviews

The possible benefits of including referring professionals in the first family interviews are being explored as a way to engage refugee families in therapy. Families in exile confront a number of problems related both to premigration traumatic exposures and to present adaptation processes. Refugee clients and the referring professionals in the larger system frequently see the problems and their solutions quite differently. This situation may often result in unclear working alliances in a context of therapy. We will describe first family interviews in which referring professionals are interviewed about their reasons for referrals, and where the families are invited to discuss these considerations. The conversations permit families, referrers, and therapists to reflect upon differences in positions and perspectives. Their experiences suggest that agreements or contracts based on these joint interviews are less ambiguous and more clearly formulated than contracts based on interviews with families alone. Finally, these experiences are discussed as a potentially valuable approach in a cross-cultural context.     

The therapist's inner conversation in family therapy practice: some ideas about the self of the therapist, therapeutic impasse, and the process of reflection.

In this article, a distinction is made between the outer therapeutic conversation and the therapist's inner conversation. The therapeutic conversation is a circle of meaning in which both the therapist and the clients play a part. The therapist's inner conversation is described as a negotiation between the self of the therapist and his role. In this process of negotiation the therapist has to take seriously, not only his observations, but also what is evoked in him by these observations, that is, images, moods, emotions, associations, memories, and so on. Furthermore, therapeutic impasse is conceptualized as a paralysis of the circle of meaning and of the therapist's inner conversation. A process of reflection is proposed as a way out of the impasse. In that process, the inner conversation of the therapist is externalized with the help of an outsider. In the final part of this article, a case study illustrates the importance of these ideas for the family therapy practice.     

Action models—learning by doing

The aim of this workshop was to demonstrate experientially how action models can be used: to highlight particular themes; to study ongoing interactional patterns of the family system; to allow patterns of behaviour and communication to emerge along with the consequences of that pattern; to focus on the process rather than the content; to find the strengths and resources of the family; and to offer the opportunity of practising new skills and to gain insight through experience. Action techniques are specific acts or actions the therapist engages in to implement a strategy. Action is a deliberate intervention which will provide material shared with the family and therapist. Five different experiential exercises were demonstrated for use in family therapy training or in family therapy sessions.     

The family therapy journals in 2002: a thematic review

This article reviews the principal English-language (including British) family therapy journals for the year 2002. A number of common themes and threads predominate within these journals. Articles relating to these themes are reported under distinct headings. These themes were: responding to 9/11; marital therapy and diversity practice. Significant research papers are incorporated into the relevant heading. This is the final thematic review undertaken by the current author.     

Teaching Family Therapy-Centered Integration: Assimilation and Beyond

This article addresses key themes in the teaching of family therapy-centered integration and describes the critical role of assimilative integration. The tenets of assimilative integration provide a framework for introducing students to multiple systemic theories and techniques while allowing them to maintain a secure base in one main theory. This form of integration is compared and contrasted to theoretical eclecticism, which guides students to become securely based in multiple theories through providing a framework for selecting which systemic approach to use when and with whom. Other issues that shape the form, content, and process of integrative training are discussed including the role of institutional culture and clinical needs, the importance of fully incorporating issues of diversity and social oppression, and the relational context within which teaching and learning take place.     

Family therapy research: Comment on “research as a family therapy intervention technique”

Wright's emphasis on and illustration of the use of family therapy research as a unique intervention technique for therapy is an important contribution to the practice literature. Equally important, however, is the isomorphic shift in focus of the family therapy researcher. Rather than focusing only on process or outcome research, family therapists should become more interested in their clients as research subjects. Though rarely discussed in the family therapy literature, the competencies of family therapists as researchers and the utility of research in a family therapy context is critical to being a well-rounded professional. Examples are provided of how this emphasis is being introduced in a PhD family therapy program.     

Therapists' perspectives on home-based family therapy

Abstract

As a result of the passage of Public Law 96-272, home-based family services have proliferated throughout the United States, with family therapy playing a vital role. Voices of therapists providing these services have been absent from literature. Ten therapists participated in this study; each had experience providing home-based and clinic-based family therapy. A qualitative strategy was used to explore therapists' perspectives on factors regarding home-based family preservation services. Four themes emerged from semistructured interviews: the home environment, safety, context preference, and efficiency and effectiveness. Three recommendations are drawn from results and discussed.     

RELATIONS BETWEEN WORK GROUP CHARACTERISTICS AND EFFECTIVENESS: IMPLICATIONS FOR DESIGNING EFFECTIVE WORK GROUPS

Five common themes were derived from the literature on effective work groups, and then characteristics representing the themes were related to effectivness criteria. Themes included job design, interdependence, composition, context, and process. They contained 19 group characteristics which were assessed by employees and managers. Effectiveness criteria included productivity, employee satisfaction, and manager judgments. Data were collected from 391 employees, 70 managers, and archival records for 80 work groups in a financial organization. Results showed that all three effectiveness criteria were predicted by the characteristics, and nearly all characteristics predicted some of the effectiveness criteria. The job design and process themes were slightly more predictive than the interdependence, composition, and context themes. Implications for designing effective work groups were discussed, and a 54-item measure of the 19 characteristics was presented for future research.