Videotaped simulated families as a tool in family therapy outcome research

Twenty-two therapists who had treated 57 families in brief conjoint family therapy under supervision responded to a videotaped simulated family as if they were treating it. Their responses were audiotaped and coded on a system devised for this study. Positive relationships were found between the ratings of expertise based on the coding system, and independent ratings of the treated families' satisfaction with treatment and the status of the presenting symptoms 6 months after termination. Videotaped simulated families are potentially useful as standardizable methods of revealing individual differences in therapists for family therapy outcome research.     

Moving from Principles to Practice: Recommended Policy Changes to Promote Family-Centered Care

This paper emphasizes the value of family-centered care. Discussion highlights family-centered philosophies (e.g., Systems of Care [SOCs]) and practice models (i.e., wraparound) and identifies discrepancies between conceptualizations and actual practice. Data from multiple sources detail issues in fidelity to family-centered values and needs and risks experienced by siblings of children with severe emotional disturbance and their caregivers. This discussion provides a springboard for policy recommendations to strengthen family support programming and enhance family-centered care, from modifying funding streams such that systems extend their reach beyond children with full-blown, diagnosable problems (those meeting standards of "medical necessity), to supporting prevention and early intervention initiatives that address families as targets for intervention. Recommendations include ensuring that communities with SOC funding address the needs of families; broadening Medicaid rules and definitions; expanding the range of reimbursable activities and services; and increasing funding for evaluating family-centered care models and family support programming.     

An Exploration of Mothers' Successful Completion of Family-Centered Residential Substance Use Treatment

Behavioral health and substance use centers have started focusing efforts on creating, adopting, and implementing evidence-based practices and programs that effectively address the needs of women and, particularly, mothers entering treatment with children. However, women with substance use disorders (SUDs) remain an underserved and understudied population; even less studied are the complexities and unique SUD treatment needs of women who have children. Family therapists' systemic training is a valued approach in conceptualizing and implementing treatment for mothers with SUDs and their families. This study explored the construct of mothering children during family-centered substance use treatment using a transcendental phenomenological approach. Analysis revealed themes related to motherhood, parenting, and support for mothers and children. Two themes emerged from the data: (a) grappling with motherhood and addiction leading to the decision for treatment and (b) specific aspects of the treatment program conducive to motherhood. Results indicated the positive impact of mothers' experiences in family-centered substance use treatment, aligning with previous literature that suggests mothers are more engaged in treatment when their children remain in their care. The insights gleaned from the participants in this study provide suggestions for further improving programming that supports mothers and their children during the recovery process. Treatment considerations are offered for family therapists working with mothers with SUDs and their families.     

Family Empowerment as a Mediator between Family-Centered Systems of Care and Changes in Child Functioning: Identifying an Important Mechanism of Change

We investigated the associations among perceived fidelity to family-centered systems of care, family empowerment, and improvements in children's problem behaviors. Participants included 79 families, interviewed at two time points across a one-year period. Paired samples t-tests indicated that problem behaviors decreased significantly across a one-year period. Hierarchical multiple regressions indicated that both fidelity to family-centered systems of care and family empowerment independently predicted positive change in children's problem behavior over a one-year period. However, when family empowerment is entered first in the regression, the relationship between fidelity to family-centered systems of care and change in children's problem behavior drops out, indicating that family empowerment mediates the relationship between family-centered care and positive changes in problem behaviors. Consistent with other literature on help-giving practices, family empowerment appears to be an important mechanism of change within the system of care philosophy of service delivery. Implications for practice and staff training are discussed.     

A Profile of Chinese Family Therapists

It is helpful for professional organizations, policy makers and regulators, third-party payers, and clients to have access to empirical data about family therapists and the practice of family therapy. Nevertheless, there is no such data available in China. This study attempts to fill this gap by profiling Chinese family therapists. A questionnaire was designed and delivered to family therapists and trainees. A total of 117 questionnaires were collected and analyzed. The findings show that the majority of Chinese family therapists are female, in the age range of 31–40 years, hold master’s degrees, and attend continuous training programs that last 20–40 days over 2–3 years and short-term workshops for family therapy training. They are mainly motivated by the need for personal growth in their career choice. Most of them work in the institutional setting. They have worked in the counseling field for 6.6 years on average, and they have practiced family therapy for an average of 3.4 years. They perform counseling for 9.2 h per week, and 4 h involve working with families. They received an average of 30.6 h of family therapy supervision in the past year. They mainly see individuals and families with adolescents, and their approach is eclectic. This paper compares the findings in China with findings from North America, discusses possible reasons for differences in the findings, and provides suggestions for future development and studies of family therapy in China.     

Do primary care psychological therapists ‘think family’? Challenges and opportunities for couple and family therapy in the context of ‘Improving Access to Psychological Therapies’ (IAPT) services

Very little couple or family work takes place in primary care despite the advantages offered by the context. This pilot study investigated the experiences of primary care adult therapists regarding the place of families in their clinical work. Semi‐structured interviews with seven therapists were analysed using interpretative phenomenological analysis. The findings tentatively suggest that primary care psychological therapists ‘think family’ primarily from the perspective of their main therapeutic model when offering individual therapy. Some study participants questioned the appropriateness of their family/context focus. Family members were extremely rarely seen together. Facilitating factors included supervision and training. Barriers to family work were both external (the work setting) and internal (beliefs about it). The impact of the current dominance of cognitive behavioural therapy in National Health Service adult psychological therapy services and the development of Improving Access to Psychological Therapies (IAPT) services on the provision of couple and family therapy are discussed. Some challenges and opportunities presented by IAPT for couple and family therapy are explored.     

Power and influence in the environment of family therapy*

This paper explores some of the ways in which family therapy theory and practice limits an appreciation of the contexts of families and family therapists. It focuses particularly upon how the rules which underlie patterns of relationships in social systems are made and maintained more by one part of a system than by another, and considers this (a) within families, (b) within various aspects of the social environment of families, and (c) within the organizational contexts of family therapists. It then proposes that the systemic thinking which family therapists apply to families is potentially applicable to wider contexts including international relationships.     

Power and influence in the environment of family therapy

This paper explores some of the ways in which family therapy theory and practice limits an appreciation of the contexts of families and family therapists. It focuses particularly upon how the rules which underline patterns of relationships in social systems are made and maintained more by one part of a system than by another, and considers this (a) within families, (b) within various aspects of the social environment of families, and (c) within the organizational contexts of family therapists. It then proposes that the systemic thinking which family therapists apply to families is potentially applicable to wider contexts including international relationships.     

Differences in family functioning in grandparent and parent-headed households in a clinical sample of drug-using African American adolescents

Grandparents play a critical role in African American families, providing support and important leadership functions. Little is known, however, about family functioning in grandparent-headed households with a drug-using adolescent. Such knowledge is particularly salient for researchers and therapists who work with drug-using adolescents and their families. Using a clinical sample of convenience, analyses were conducted to identify similarities and differences in adolescent substance use and behavior problems, family relationships, and family social ecology relationships between African American grandparent-headed (n=12) and parent-headed (n=54) households. Results indicated that adolescents from the 2 household types reported similar levels of problem behaviors, but that grandparents reported less delinquency with peers than did parents. Primary caregivers in grandparent-headed households reported less monitoring and supervision of peers and less within-family conflict. Implications for treatment are discussed.     

Media reviews

Abstract

Dr. Maurizio Andolfi is Director of the Family Institute in Rome, Italy. He was trained in family therapy in the United States and now frequently returns to give seminars and demonstrations of his particularly gifted systems approach in the treatment of families, and in supervision of family therapists. Dr. Joel Bergman, a member of the senior faculty at the Ackerman Family Institute, reviews two of Andolfi's videotapes dealing with the supervisory process, and illustrated by actual clinical material.

The mirroring and reduplication of patterns often occurs when systems interface. Family dynamics repeat themselves across generations, and therapists and therapeutic teams easily become enmeshed in the powerful intricacies of family systems. The work of Andolfi highlights the importance of using the therapist's self-experience to illuminate and effect change in the family interactions, and the awareness of the contextual complexities of the supervisory process provides further possibilities for more enlightened intervention.—I. A.     

Putting families in the center: family perspectives on decision making and ADHD and implications for ADHD care

Objective: To examine components of family-centered care in families' stories about treatment decision making for their child with ADHD. Method: Twenty-eight families participated in qualitative interviews that addressed families' perspectives on (a) the treatment decision-making process, (b) the cause and impact of their child's symptoms, and (c) treatment goals and preferences. Results: The majority of families preferred to be primary or shared decision makers regarding treatment decisions. Families' perspectives on the cause of the child's symptoms varied and often were not consistent with a biomedical framework. Families described multiple areas of impairment on child, family relationships, and family functioning. Perspectives toward evidence-based treatments were mixed, with families also expressing interest in and pursuing interventions not delineated in current treatment guidelines. Conclusion: These findings reinforce the importance of eliciting families' perspectives and involving these important stakeholders in shared decision making as critical components of family-centered care for children with ADHD.     

Police Families: Stresses,Syndromes, and Solutions

Law enforcement families experience a variety of both commonplace and unique stressors. This article discusses the main forms of police family stresses and crises and offers a range of practical solutions that family therapists can use to help these families cope and thrive. Especially with this kind of population, the emphasis is on both direct clinical services and a coaching-style, self-empowerment model that therapists can productively utilize in helping officers and their families to help themselves.     

Family therapy and outcome: Relationships between therapist and family styles

This study examined therapeutic outcome for a group of 175 clinic families divided into levels of family competence and style, and, later, into seven clinical groupings. The division into these groups was based on the level of rated Competence and Style determined by using the Beavers Systems Model. Therapists also rated their level of Openness/Sharing Strategy, Power Differential, and Partnership with the family at the third session. Results indicate that more competent families who fared well in therapy had therapists who formed a partnership, disclosed strategy, and employed a minimal power differential with the family. The most disturbed families, and those with a Centrifugal style, did better with therapists employing a high power differential and lower levels of openness and partnership. The study also presented the distribution of individual diagnoses by family groups. Implications for family therapists, including the value of family assessment, are provided.     

Long-Term Trajectories and Service Needs for Military Families

The deployment of US military personnel to recent conflicts has been a significant stressor for their families; yet, we know relatively little about the long-term family effects of these deployments. Using data from prior military service eras, we review our current understanding of the long-term functioning and needs of military families. These data suggest that overseas deployment, exposure to combat, experiencing or participating in violence during war deployment, service member injury or disability, and combat-related post-traumatic stress disorder (PTSD) all have profound impacts on the functioning of military families. We offer several recommendations to address these impacts such as the provision of family-centered, trauma-informed resources to families of veterans with PTSD and veterans who experienced high levels of combat and war violence. Recent efforts to address the needs of caregivers of veterans should be evaluated and expanded, as necessary. We should also help military families plan for predictable life events likely to challenge their resilience and coping capacities. Future research should focus on the following: factors that mediate the relationship between PTSD, war atrocities, caregiver burden, and family dysfunction; effective family-centered interventions that can be scaled-up to meet the needs of a dispersed population; and system-level innovations necessary to ensure adequate access to these interventions.     

Work and Family Conflict: An Often Overlooked Issue in Couple and Family Therapy

Despite the systemic interaction, family-based journals, as well as intake and assessment forms most frequently used by couple and family therapists (CFTs), have given a limited amount of attention to the issue of work and family conflict. Moreover, a review of the literature indicated that many CFTs perceive themselves as inadequately prepared to assist couples and families with work and family conflict. Addressing this apparent limitation, the present study identified various work stressors that contributed to family conflict (WFC), and the family stressors that contributed to work conflict (FWC). Results revealed significant predictors of WFC and FWC. Implications for CFTs and recommendations for changes in academic training and supervision are provided. The authors would like to thank Dr. Gary Bischof, Associate Professor of Counselor Education and Marriage and Family Therapy program Director at Western Michigan University, for editorial comments made on a previous version of this paper.     

Psychologists' role in family-centered approach to practice, training, and research with young children

Family-centered, community-based, coordinated care for children with special needs is presented as the best practice model for providing services to children and families. Psychologists must learn to play an active role in this frame-work that both integrates psychology with other health and education disciplines and uses the broad spectrum of psychological knowledge about families, development, community organization, and intervention strategies. Key principles of family-centered child psychology affect practice research and training. The psychologist becomes part of a team created to support families as the primary care-givers of their children. Training programs must reorganize the types of experiences both in the classroom and the field to train new psychologists within this model. As mandates for family-centered care affect policies at the state and federal levels, research will remain a critical factor in understanding the effects of these policy shifts on child and family functioning and the delivery of services.     

Direct Open Supervision: A Team Approach

Created in the absence of one-way mirror facilities, Direct Open Supervision combines elements of live supervision with team participation in training family therapists. The theory and application of this approach to direct supervision are described.     

What we say we do: results of the 1997 UK Association of Family Therapy Members Survey

This study represents the first UK national survey of family therapists and systemic practitioners. The aim was to provide demographic information of systemic practitioners/family therapists and also to describe their clinical practice. The sampling frame used was the UK Association of Family Therapy membership list and all members were sent a postal questionnaire. The response rate was 33% with 495 out of 1500 questionnaires returned. Among the major findings were: systemic practitioners/family therapists are most likely to work for an NHS trust, to use family therapy techniques/systemic ideas predominantly, and to treat a broad range of client issues. They are also most likely to work with families, and therapy is relatively short term (five to eight sessions) regardless of whether they treat families, couples or individuals. Most family therapists/systemic practitioners use some measure of outcome, although frequently this will be feedback from clients. Supervision is sought by the majority of AFT members. In spite of some methodological limitations, the study provides interesting insights into the training and practice of UK family therapists and systemic practitioners which appears to differ in some respects from our American colleagues. It also provides a baseline for future surveys, making it possible to describe the developments of family therapy and systemic practice in this country.