Do Better Trainees Make Worse Family Therapists? A Followup Study of Client Families

This study was designed to evaluate the effects of training on family therapy outcome and to validate measures of cognitive/perceptual and executive skills. Followup data on family satisfaction were obtained from 176 individuals (73 families) treated by 12 trainee family therapists in their first or second year of training. The prediction that clients' scores on a scale of family satisfaction with therapy (FSS) would increase with training was not confirmed. Instead, there was a tendency for FSS scores to decrease with training. However, trainees' ratings of outcome did increase significantly as training progressed. Cognitive/perceptual and executive skill measures were not validated by the FSS, but negative associations indicated a tendency for trainees with high course-skills to receive poor FSS scores. The results suggest that trainees became more confident as they acquired technical skills, but that they put aside their nonspecific therapist skills as training progressed, to the dissatisfaction of families.     

Family Therapy and Drug Abuse: A National Survey

The following report describes the results of a national study of the role of family therapy in the drug abuse field. Characteristics of agencies that work with families are described, as well as the demographic characteristics and psychological problems of the clients most apt to be treated in family therapy. The study also looks at the role and structure of family therapy in the ecological system of the treatment institutions. A profile of the family therapists who are responsible for providing services to families is presented. An attempt was made to assess agencies' level of development with regard to family therapy by using an instrument, The Progress Index for Family Therapy Programs. Generally, findings indicated that there is considerable variation in expertise. More extensive training in family therapy techniques was of major concern, particularly among clinics with a heroin addict population.     

Client-level predictors of adherence to MST in community service settings

This study examined the association of youth and family characteristics with therapist fidelity to an evidence-based treatment provided in real world practice settings. Participants were 233 families that reported on the 66 therapists organized into 16 teams in nine organizations providing multisystemic therapy (MST). Therapist adherence ratings were lower for youths referred for both criminal offenses and substance abuse than for youths referred either for substance abuse or status offenses, and was negatively associated with pretreatment arrests and school suspensions. Adherence ratings were positively associated with educational disadvantage and caregiver-therapist ethnic match and marginally positively associated with economic disadvantage. The findings suggest directions for future research on the implementation of evidence-based treatments in community settings.     

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.     

Therapists Ratings of Fundamentalist and Nonfundamentalist Families in Therapy: An Empirical Comparison

Using the Family Health Scale, Part I of an instrument developed for this study, two randomly selected groups of certified family therapists rated either nonfundamentalist or fundamentalist families in therapy on eight recognized indicators of family health. Factor analysis yielded eight factors accounting for 66% of the variance between groups. Cannonical discriminant function analysis revealed that therapists rated fundamentalist families as significantly less healthy on three of the eight factors and more healthy on one factor. Part II of this instrument, the Religion Impact Scale assessed the effects of church community and church teachings upon families. For fundamentalists, the church and concomitant belief system had a significant impact upon family organization and functioning. Theoretical and clinical implications of these findings are discussed.     

Perceptions of the therapist in family therapy

Thirty-five families completed ratings describing their perceptions of their therapists. These ratings were then correlated with measures of outcome to assess whether there was a relationship between experiences of the therapist and treatment outcome. Further, the study addresses whether some family members' perceptions are more influential in affecting the course of treatment. The results showed that family members' perception of the therapist does have an impact on treatment outcome, but not all members affect the outcome equally. Further results and their implications are discussed.     

Difficulty in implementing a family intervention for bipolar disorder: the predictive role of patient and family attributes

Family affect was examined as a predictor of difficulty implementing a 9-month, manual-based, psychoeducational family therapy for recently manic bipolar patients. Prior to therapy, family members were administered measures to assess both their expressed emotion and affective behavior during a family interaction task. Following family treatment, both therapists and independent observers rated the overall difficulty of treating the family, and therapists also rated each participant's problem behaviors during treatment, in the areas of affect, communication, and resistance. Therapists regarded affective problems among relatives and resistance among patients as central in determining the overall difficulty of treating the family. Relatives' critical behavior toward patients during the pretreatment interaction task predicted both independent observers' ratings of overall treatment difficulty and therapists' perceptions of relatives' affective problems during treatment. Moreover, patients' residual symptoms predicted independent observers' ratings of overall difficulty and therapists' perceptions of patients' resistance to the family intervention. Results suggest that difficulties in conducting a manual-based family intervention can be predicted from systematic, pretreatment family and clinical assessment.     

The ‘healthy’ family*

The importance of concepts and hypotheses about ‘healthy’ families for family therapists is stressed. A number of different approaches to defining ‘health’ is described. Concepts and hypotheses of family therapists from different schools are integrated into a more encompassing theory, thereby focusing on statements with respect to personality, cognition, behaviour, communication, relationship, role, family system and network. It is noted that family therapy literature lacks information about ‘healthy’ families. Moreover, nearly all statements are non-scientific and normative as they are not founded on empirical research.     

Using Minuchin's structural family therapy techniques with Italian-American families

Italian-American families have general characteristics about which family therapists should be informed in order to select appropriate and effective family therapy for this cultural group. The author identifies Minuchin's structural family therapy techniques as relevant for working with Italian-American families, adding a note of personal validation of the need and efficacy of the Minuchin approach.     

Boundary regulation in family and personal systems: Perceptions of late adolescents

Examination of boundary regulation can provide family therapists with a framework to describe both the functioning of family systems and personal systems (i.e., the intrapsychic functioning of individual family members). In the present study, late adolescents' perceptions of boundary regulation within their family systems (i.e., ratings of family health, communication, leadership, expressiveness, cohesion, and family conflict) were related to regulation of their personal boundaries (i.e., self-reported personal competence, distress, and patterns of defense mechanism use). In addition, personal system variables reliably discriminated between adolescents who described their families as psychologically healthy versus psychologically unhealthy.     

Should I give advice? A systemic view

Giving advice is considered from i he viewpoint of Milan systemic family therapy, and the possibility of its always being a therapeutic error is discussed. The beliefs of both professionals and clients concerning advice are examined. What can systemic therapists do if families ask for advice, and when is direct advice useful? Effects on therapists and families of giving advice are discussed as well as ways of limiting possible damage to the process of therapy. Questioning techniques are considered as an alternative that allows families to discover their own solutions.     

Family Therapy in Chinese Culture and Context: Lessons from Supervising Therapists-in-Training in China

Systemic family therapy as an essential paradigm for treating couples and families has gone global since its initial rise to popularity. According to researchers, China has signaled a strong desire for training in systemic family therapy. Even though this mode of mental health service is a foreign import to China, the surge in interest for Western psychotherapy for individuals and families grows by leaps and bounds. However there has been evolving conversations about the transportability of systemic family therapy from the West to the East. Using a qualitative focus group format, this study explored the experiences of sixteen Chinese couple and family therapists on their perspectives in adapting systemic family therapy concepts to the local Chinese context. Results reveal the interplay between the systems of the changing Chinese family structure and of the application of family therapy models that originated from the West must work harmoniously in order to enhance the goodness of the familial system within the evolving Chinese society in the 21st century.     

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.     

Global Mental Health: A Call for Increased Awareness and Action for Family Therapists

Global mental health (GMH) is an emerging field that focuses on the need for culturally sensitive mental health services in low‐ and middle‐income countries (LMICs). While many new initiatives have been established worldwide to understand GMH needs and to provide care in LMICs, family therapists have primarily worked with families in high‐income countries. The few existing family‐based initiatives in GMH focus on psychoeducation and are typically not based on general systems theory. However, emerging trends in family therapy may enable family therapists to impact mental health issues in LMICs. These trends, which are shared interests of both family therapy and GMH, include collaborative care, a growing emphasis on the importance of culture in understanding and treating mental health issues, recognition of the ability of families to support or impede recovery from mental illness, and the use of strength‐based and evidence‐based treatments. This paper describes ways for family therapists to become active in the GMH community.     

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.     

Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists’ Observable Behaviors

This study aimed to compare therapists’ observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists’ contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients’ engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists’ alliance‐building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research.     

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.