Impact of Co-Therapy Teams on Client Outcomes and Therapist Training in Marriage and Family Therapy

This study of 33 student therapists, 402 client systems, and three supervisors tested the efficacy of using student co-therapy teams as an aspect of clinical training in a marriage and family therapy program. This study utilizes both quantitative and qualitative methodology. Two research questions were addressed: “Do different pairings of co-therapists affect client outcomes?” and “Is co-therapy a viable option for a training program?” The results indicate that client outcomes using co-therapy are at least as effective as treatment using one therapist and in some circumstances produce more positive outcomes for both clients and student therapists.     

The Effect of Therapist–Client Racial Similarity on Client Satisfaction and Therapist Evaluation of Treatment

Client satisfaction with therapy services and therapists' perspectives of treatment evaluation were examined in relation to therapist and client racial similarity. Secondary data from a university marriage and family therapy clinic located in the southeast was used to pair therapists and clients on racial similarity or difference. Statistical analyses revealed no major differences in clients' perceptions of satisfaction based on similarity to therapists' race. Therapists indicated some differences in their perceptions of the success of services provided to clients based on similarity to client's race. Implications for researchers, clinicians, and educators are included.     

Beyond the Frying Pan: Addressing Work Issues with Women in Therapy

In recent years, mental health practitioners have been exploring how women are balancing work and family. Given how this issue affects womens experiences in the corporate world and at home, marriage and family therapists are attempting to consider this concern as they treat female clients individually and within relational systems. Few articles and studies have examined the issues female employees face in the workplace and how the issues influence the therapeutic process. In this article, the authors examine the organizational, sociological, and cultural challenges women deal with at work and apply these areas to the therapeutic context. The authors present a case study of a female client enduring a difficult work situation, discussing how to view and approach this case from a feminist family therapy perspective.     

Marriage and Family Therapy with Low-Income Clients: Professional,Ethical, and Clinical Issues

Economic stress greatly increases the likelihood of mental health issues occurring within a family. Although this is widely known within the mental health profession, there is a lack of literature that assists therapists in working effectively with low-income clients. As a result, marriage and family therapists may be ill equipped to meet the needs of those in poverty, and may even be conducting therapy that is ethically unsound. The authors of this article discuss several ethical and professional issues regarding therapy with families in poverty. A number of suggestions are presented for improving the effectiveness of therapy with low-income clients. Michele E. Grimes and Alyssa D. McElwain are masters students in Marriage and Family Therapy at Purdue University Calumet, Hammond, IN. Michele E. Grimes and Alyssa D. McElwain contributed equally to this article.     

Creative Occupational Therapist: It's About the Client Using Focus Groups to Explore Creativity in Occupational Therapy

Although creativity is an important aspect of occupational therapy theory and practice, there have been few studies that would explore this concept in the context of the occupational therapy process. This was the first qualitative study of creativity in occupational therapy in Slovenia. It was conducted as part of a larger mixed-methods study and included 22 experienced occupational therapists who participated in four focus groups. The focus of the study was on the exploration of different factors that could contribute to creativity and creative strategies in occupational therapy, in either a positive or a negative way. Since occupational therapy promotes a client-centered therapy approach, the role of the client as the motivating factor was of particular interest to our study. Six factors that can influence the creativity of occupational therapists emerged from the qualitative analysis (Strauss & Corbin, 1990). While the client was identified as the key factor, the potential of other factors was also recognized. This qualitative study increased the understanding of the concept of creativity and creative behavior in occupational therapy, and also provided empirical material that formed the basis for the development of a questionnaire on creativity in occupational therapy.     

The Contributing Factors of Change in a Therapeutic Process

The clients’ and therapists’ perceptions about the degree to which each of four common factors in therapy—extra-therapeutic factors; model/techniques; therapeutic alliance; and hope/expectancy—contribute to change in the therapeutic process were investigated in this study. In addition, the perceptions about the percentage of change attributed to clients and therapists were also explored. Results revealed that the therapists and clients have different perceptions on what factors contribute the most to change and that clients and therapists believe that the client contributes the most to change in a therapeutic process.M. L. Thomas, MSW, is a doctoral student in Marriage and Family Therapy at Florida State University.     

The cost of treating substance use disorders: individual versus family therapy

This study examined the cost of substance use disorders treatment in a large healthcare organization. A survival analysis demonstrated that family therapy utilised the least number of sessions (M = 2.41) when treating substance use disorders followed by individual therapy (M = 3.38) and mixed therapy (M = 6.40). Family therapy was the least costly of the three types, at $124.55 per episode of care for a client, with individual therapy costing $170.22 and mixed therapy $319.55. The ratio of family therapists utilising family therapy was more than three to one compared to other licensed professionals. The percentages of clients coming back for more than one episode of care are fewest for family therapy (8.9%) followed by mixed therapy (9.5%) and individual therapy (12.0%).     

Transformations in Therapeutic Practice

In her training of therapists, Virginia Satir sought to change the way her trainees perceived themselves, their clients, and the therapeutic endeavor. The change she sought was a movement from hierarchical models of therapy where clients were diagnosed in terms of paradigms of how they ought to be to an organic model where the therapist attempts to understand the client by entering the client's internal context. Contemporary training in the Satir model attempts to bring about the same change. Research indicates that the trainers are succeeding.     

Response to commentary: is collaboration a viable target for family therapists?

In response to Zimmerman's commentary, ‘Is collaboration a viable target for family therapists?’ we explore more conventional perspectives of therapeutic collaboration featured in the family therapy literature, including Zimmerman's commentary. In particular, we critique essentialist and universal formulations that portray the client–therapist relationship to be inherently unequal as inconsistent and limiting. We conclude by addressing what appear to be some misunderstandings in Zimmerman's commentary and clarify what we see as differences between his ideas and our stance on collaboration and power in family therapy.     

An Integration of Feminism into Experiential Psychotherapy

Abstract

Feminist therapy altered how marriage and family therapists conceptualized their clients’ realities and psychopathology. Upon an extensive search of the literature, there is a sparse amount of literature regarding the integration of feminist therapy with experiential therapy. The authors discuss feminist and experiential therapy models, propose a model of feminist-experiential therapy, and highlight the need and fit of these theories. A discussion on giving space to silenced voices, establishing an egalitarian relationship, expanding the definition of deviance, and exploring the importance of language will be done to aid the experiential therapist in their work and expand their client’s experience.     

Working with Families from the Indian Sub-Continent: An Indo-German Experience*

Whereas most Western European therapists and clients consider emotional distance and abstinence as desirable and conducive in the therapeutic process, this may not always be the case with clients from India. Cultural components such as the contrast between linear and cyclic world-views and the traditional view of the psychologist as an advisor in India present a challenge to professionals with a Western background. Some factors such as the situation of women in society and seemingly too close familiy ties can mean that a Western therapist fails to promote the changes an Indian client is desiring for his or her family. However, besides cultural awareness and caution, one of the most helpful tools in work across cultures is curiosity in its most positive sense and the readiness to be surprised by ones’ clients.I would like to thank all my Indian colleagues who supported and advised me in my work in India.     

Therapists’ experiences with internal representations of clients

Fourteen therapists were interviewed via telephone regarding their experience of “carrying around” their clients with them between sessions (i.e. internal representations, or IRs, of clients), a phenomenon about which little empirically based knowledge exists. Data were analyzed using consensual qualitative research. Findings indicated that overall, therapists have IRs infrequently, most often have IRs of clients struggling with severe or challenging presenting problems, and do receive some training about IRs. When describing a specific IR experience, therapists typically noted a strong therapy relationship, and stated that the IRs typically had specific triggers. The IRs generally consisted of feelings about the client, and typically consisted of thoughts about the client or the felt presence of the client. The IRs generally yielded positive effects, typically both personally and professionally, and were typically discussed with supervisors/consultants. Implications for research, training, and practice are presented.     

Honoring Protective Responses: Reframing Resistance in Therapy Using Polyvagal Theory

Therapists often conceptualize resistance as client behaviors that impede progress; this perspective threatens the therapeutic alliance, especially in couple and family therapy where increased resistance and multiple alliances are present. Polyvagal theory reframes and normalizes resistant behaviors as preconscious, protective responses emerging from our autonomic nervous system. The theory also explains how humans reciprocate safety cues to connect with each other; therapists can use concepts of polyvagal theory to manage their own emotional regulation and foster safety and connection in therapy. Polyvagal concepts deepen our understanding of protective behaviors presenting in couple and family therapy; therapists can help couple and family clients to recognize protective behaviors in their own relationships and facilitate safer connection and engagement. Clinical implications are presented: psychoeducation can help clients normalize and understand their protective processes; therapist presence and immediacy acknowledges and normalizes protective behaviors as they arise; therapist and client self-regulation skills support connection; therapist genuineness is a precondition to client safety; and understanding of polyvagal theory enhances assessment of conflict and enactments in couple and family therapy.

     

Client concealment and self-presentation in therapy: comment on Kelly (2000)

The authors disagree with A. E. Kelly's (2000) conclusions that clients conceal things from therapists primarily for self-presentational reasons and that client concealment is positively related to positive therapy process and outcome. They also disagree with A. E. Kelly regarding the implications of self-presentation theory for therapy. Their review of the research suggests that clients do not conceal much from therapists, that what they do conceal involves many different kinds of information hidden for many different reasons, that therapists have wide variability in being able to detect hidden client material, and that the relationship of client concealment and therapist awareness of client concealment with therapy process and outcome is not clear. Finally, the authors discuss their views about implications of client concealment and self-presentation for therapy.     

The Role of Creativity in Marriage and Family Therapy Practice: A National Online Study

The purpose of this study, using an online methodology, was to investigate therapists' perceptions of the role of creativity in couples' and family therapy. Along with completing a quantitative measure assessing creativity in their work, participants responded to four open-ended questions which addressed the meaning of creativity, characteristics of a creative family therapist, some creative interventions they have used with couples and families, and barriers to their own creativity as a family therapist. A total of 142 marriage and family therapists in 36 states in the United States participated. The findings shed light on the unique importance of creativity in couples and family treatment.     

正式反馈的发展与临床应用

摘要:正式反馈通过系统收集当事人的效果反馈来追踪其治疗进展,进而识别缺乏治疗进展的个案,并通过促进治疗策略的调整来阻止治疗失败。正式反馈是近20年来发展出的一种循证治疗手段,其目的为进一步提高当事人的咨询效果。正式反馈的发展大致经历了临床有效性检验和实用性发展两个阶段。正式反馈可用于促进个体、夫妻和团体咨询的效果,也可用于评估临床督导效果、确定督导个案和指导临床督导。未来研究可探讨咨询师对待正式反馈的态度,拓展正式反馈的使用价值,建立正式反馈系统的本土化常模。     

Therapist empathy,homework compliance,and outcome in cognitive behavioral therapy for generalized anxiety disorder: partitioning within- and between-therapist effects

Although client-perceived therapist empathy relates to positive therapy outcomes, including in cognitive behavioral therapy (CBT), little is known about how empathy exerts its ameliorative effect. One possible way is by promoting clients’ subsequent homework compliance, a variable that also predicts positive outcomes in CBT. The present study sought to investigate simultaneously, in the context of 43 therapist–client dyads receiving 15 sessions of CBT for generalized anxiety disorder, (1) the association of early client-perceived therapist empathy (averaged over sessions 1, 3, 5) with mid-treatment client homework compliance (averaged over sessions 6, 8, 10); (2) the association of mid-treatment homework compliance on client posttreatment worry severity; and (3) the indirect effect of early perceived therapist empathy on posttreatment worry through mid-treatment homework compliance. Given that clients were nested within therapists, we examined both within- and between-therapist differences in clients’ ratings of therapist empathy and homework compliance, and tested both of these indices as predictors of the relevant dependent variables in a multilevel model. At the within-therapist level (i.e., differences between clients within a given therapist’s caseload), greater early empathy was associated with greater mid-treatment homework compliance. At the between-therapist level (i.e., differences between therapists across all of their cases), greater between-therapist homework compliance was related to lower posttreatment worry. Finally, homework compliance was not found to mediate the relationship between empathy and posttreatment outcome. The results underscore the importance of parsing client and therapist effects, and are discussed with regard to their training and research implications.     

‘The experiencing of experience’: a Pragmatic reassessment of Rogerian Phenomenology

This paper draws on a study that asked twenty family users about their first session of family therapy. Analyses of the interviews indicated that families entered therapy with a pre-existent knowledge about therapy, which did not always chime with those of professionals and which positioned speakers in ways which governed their expectations and perceptions of therapy. This paper, therefore, is concerned with the acquisition and deployment of knowledge: specifically, the knowledge involved in being a user of family therapy. Three key discourses were identified through this analysis: medical, counselling and consumerist. We aim to illustrate how these discourses served as a resource for members of the family in constructing therapists, therapy and themselves in relation to their experience. The examination of the rhetorical, ideological and practical effects of the positions chosen and the objects constructed, in terms of how speakers wanted to present themselves, with what enhanced or diminished status as patients, shows users actively engaging with the power of therapeutic institutions. Users’ accounts suggest that while most speakers felt anxious about the prospect of therapy, there were clear differences in overall satisfaction/dissatisfaction with the experience according to the synchrony between speakers’ construction of the therapist, and themselves as client/patients. Those who seemed to take a traditional view of therapy within a medical discourse valued therapists who offered diagnosis and a cure; those who sought and experienced a counselling relationship with the therapist found their experience to be constructive in terms of enhanced self-knowledge. We believe that the research findings discussed in this paper have implications for family therapists in accommodating to parental and child positions to maximise the effectiveness of therapy and so minimise drop-out.