Human‐Animal Bonds II: The Role of Pets in Family Systems and Family Therapy

The vast majority of pet owners regard their companion animals as family members, yet the role of pets in family systems and family therapy has received little attention in research, training, and practice. This article first notes the benefits of family pets and their importance for resilience. It then examines their role in couple and family processes and their involvement in relational dynamics and tensions. Next, it addresses bereavement in the loss of a cherished pet, influences complicating grief, and facilitation of mourning and adaptation. Finally, it explores the ways that clients' pets and the use of therapists' companion animals in animal‐assisted therapy can inform and enrich couple and family therapy as valuable resources in healing.     

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.     

Qualitative Exploration of an Effective Depression Literacy Fotonovela with at Risk Latina Immigrants

While depression is prevalent among immigrant Latinas, mental health literacy is low. Culturally tailored health narratives can improve mental health literacy and are now increasingly featured in Spanish language fotonovelas (i.e., booklets in a comic book format with posed photographs and dialogue bubbles). The purpose of this qualitative study is to explore why a depression literacy fotonovela proved effective with Latina immigrants at risk for depression in a quantitative randomized control study. This study is the qualitative companion of the previously published quantitative piece of a mixed methods study, the latter revealing posttest improvements in depression knowledge, self‐efficacy to identify the need for treatment, and decreased stigma towards mental health care (Hernandez and Organista in Am J Community Psychol 2013 . doi:10.1007/s10464‐013‐9587‐1). Twenty‐five immigrant Latinas participated in structured interviews, in the current qualitative study, 3 weeks after participating in the quantitative study. Results suggest depression literacy improved because participants evidenced high recall of the storyline and characters, which they also found appealing (e.g., liked peer and professional support offered to depressed main character). Further, identification with the main character was reflected in participants recalling similar circumstances impacting their mental health. Despite some improvement, stigma related to depression and its treatment remained for some women. Future research for the improvement of health literacy tools is discussed.     

Diagnoses,Relational Processes and Resourceful Dialogs: Tensions for Families and Family Therapy

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5), given its psychiatric focus on mental disorders in individuals, presents families and family therapists with challenges. Despite considerable controversies over its adoption, the DSM‐5 extends a process of standardizing a language for human and relational concerns. No longer a diagnostic language of professionals alone, its use is medicalizing how mental health funders and administrators, as well as clients, respond to human concerns. For family therapists who practice systemically, particularly from poststructuralist and strengths‐based orientations, many tensions can follow when use of the DSM‐5 is expected by mental health administrators and funders, or by clients who present concerns about themselves or a diagnosed family member. In this paper, I explore how such DSM‐5 related tensions might be recognized, navigated, and negotiated in the practice of family therapy with clients, and with administrators and funders.     

Description of Relational Processes: Recent Changes in DSM‐5 and Proposals for ICD‐11

Epidemiologic, prospective, and retrospective research confirms that family relational variables are significant risk factors for the development of mental and physical health problems in children as well as adults. In addition, relationships also play a moderating role in the maintenance, exacerbation, or amelioration of chronic health problems. Although acknowledgment of the importance of these variables in the pathophysiology of a number of health conditions is reaching more prominence, the integration of assessments of family factors as part of standard health care has made little progress. With the arrival of the Affordable Care Act in the United States, there is a desire for earlier identification of these risk factors, and the ability to implement prevention programs that reduce risk, and enhance protective factors. On a global level, there is increased awareness of the health impact of relational problems, for example, many countries have attempted to implement programs to decrease domestic violence. More reliable and standardized assessments of key relational processes will enhance both of these missions, and allow comparison of a variety of prevention and intervention programs. This article discusses progress over the last decade in constructing more reliable definitions of relationship processes, how these have been integrated into the Diagnostic and Statistical Manual 5th edition (DSM‐5), and progress toward implementation into the World Health Organization's International Classification of Diseases (ICD‐11).     

Research in counselling and psychotherapy Post‐COVID‐19

The COVID‐19 pandemic brings to light many areas the field of counselling and psychotherapy may need to address in future research. We outline several issues stemming from or exacerbated by the pandemic and offer suggestions for future research to address the mental health needs of those impacted. Our suggestions focus on five domains: (a) the health and well‐being of helping professionals, (b) the infodemic, (c) discrimination and minority stress, (d) spiritual and existential dynamics in mental health and (e) couple and family stress and resilience. We aim to provide a multi‐systemic perspective of mental health and well‐being in the time of COVID‐19, as well as encourage current and future studies to incorporate these suggestions to advance the health and well‐being of our communities through evidence‐based treatment approaches.     

Is Group Singing Special? Health,Well‐Being and Social Bonds in Community‐Based Adult Education Classes

Evidence demonstrates that group singing improves health and well‐being, but the precise mechanisms remain unknown. Given that cohesive social networks also positively influence health, we focus on the social aspects of singing, exploring whether improvements in health and well‐being are mediated by stronger social bonds, both to the group as a whole (collective‐bonding) and to individual classmates (relational‐bonding). To do so, seven newly formed community‐based adult education classes (four singing, N = 84, and three comparison classes studying creative writing or crafts, N = 51) were followed over seven months. Self‐report questionnaire data on mental and physical health, well‐being and social bonding were collected at Months 1, 3 and 7. We demonstrate that physical and mental health and satisfaction with life significantly improved over time in both conditions. Path analysis did not show any indirect effects via social bonding of Condition on health and well‐being. However, higher collective‐bonding at timepoint 3 significantly predicted increased flourishing, reduced anxiety and improved physical health independently of baseline levels. In contrast, relational‐bonding showed no such effects, suggesting that it is feeling part of a group that particularly yields health and well‐being benefits. Moreover, these results indicate that singing may not improve health and well‐being more than other types of activities. Nonetheless, these findings encourage further work to refine our understanding of the social aspects of community‐based adult education classes in promoting health, well‐being and community cohesion. Copyright © 2016 John Wiley & Sons, Ltd.     

Leadership in community mutual support groups for mental health: A qualitative case study from the leaders' perspective

This study explores the experience of leadership of member‐led community‐based mental health mutual support groups. Recent research has documented factors that affect these groups, including leader well‐being, but little is known about the experience of leadership at the individual level. We aimed to understand more about the experience of leadership and how leading members conceptualise their roles. Individual semi‐structured interviews were conducted with 14 leaders of a community mental health mutual support group in England and thematically analysed. Three themes were identified through which leading members conceptualised their roles and group dynamics: (a) “It's a family”; (b) professional values; and (c) working as a team. These knowledge frameworks appeared to influence leaders' well‐being and conceptualisations of their role. The potential impact of this on group stability is discussed. Recommendations are made that group and individual‐level processes be considered together in future research in mental health mutual support contexts due to their interconnected nature.     

Philosophical dialogues as paths to a more ‘positive psychology’

Although family support programmes have been in place for several decades in Greece very little attention has been paid to evaluating the effectiveness of such endeavours, the techniques that influence their outcomes and the receptiveness to their messages. The purpose of this paper is to give an overview of research findings collected during the first qualitative research phase of a community mental health promotion project. The research was conducted in order to delineate programme outcomes and the characteristics that had an impact on the participants' lives. The 3‐month family support programme intended to introduce ‘philosophical dialogues’ as means to developing personal and communal understandings of what makes life worth living. The programme was developed and implemented on Crete under the auspices of a non‐profit community organization appropriately named ‘The Lyceum for Women’. The features of the programme that contributed and enhanced the participants' tendencies to become not passive targets but active partners and stakeholders in the process will be clarified, as will the conceptualization and approach. Of the 45 evaluation protocols that were analysed the following themes were most important for the participants: ‘Group as‐a‐whole process’—the sense of sharing and development understandings in a ‘parea’ (in‐group); ‘relational outcomes’—feeling of belonging, ‘reciprocated kindness’, and giving of self to others; personal and emotional outcomes‐self‐efficacy and empowerment; knowledge outcomes‐learning about positive emotions and enjoying the simple things in life; and group facilitator outcomes‐sharing stories, ‘gives of self to the community’. Copyright © 2007 John Wiley & Sons, Ltd.     

Fortalezas Familiares Program: Building Sociocultural and Family Strengths in Latina Women with Depression and Their Families

The purpose of this article is to describe Fortalezas Familiares (FF; Family Strengths), a community‐based prevention program designed to address relational family processes and promote well‐being among Latino families when a mother has depression. Although depression in Latina women is becoming increasingly recognized, risk and protective mechanisms associated with children's outcomes when a mother has depression are not well understood for Latino families. We begin by reviewing the literature on risk and protective psychosocial mechanisms by which maternal depression may affect Latino youth, using family systems theory and a developmental psychopathology framework with an emphasis on sociocultural factors shaping family processes. Next, we describe the theoretical basis and development of the FF program, a community‐based 12‐week intervention for Latina immigrant women with depression, other caregivers, and their children. Throughout this article, we use a case study to illustrate a Latina mother's vulnerability to depression and the family's response to the FF program. Recommendations for future research and practice include consideration of sociocultural processes in shaping both outcomes of Latino families and their response to interventions.     

The Future of Psychology in Family Medicine

Psychology has been integral to the field of family medicine since its inception as a medical specialty in the 1960s. Psychologists and other behavioral scientists contribute to family medicine in teaching clinical skills, in defining research questions, in developing research methodology, and in creating integrated physical/mental health care delivery systems. Future developments in the field of psychology in family medicine are likely to emphasize development and evaluation of screening measures which identify mental health problems in primary care, development of early intervention for those mental health problems, and more precise measurement of process and quality of care and health outcomes. Psychologists have an important role to fulfill in educating physicians on alternatives to pharmacologic and medical interventions for common presenting problems in primary care. However, current economic forces shaping the practice of medicine may work against further enhancing the efficacy of the physician in dealing with psychosocial issues. The future role of psychology in family medicine is not yet delineated, and while the move toward parity of reimbursement for mental and physical health care delivery may enhance this collaboration, there is a need to continue to evaluate how the psychological well-being of patients is influenced in the evolution of new models of care delivery.     

Exploring Levinas: the ethical self in family therapy

From a systemic perspective, people are relational beings located in wider systems of interaction, conversation and meaning. As for social constructionists, the self is positioned and storied through language and dialogue. Yet is the self no more than the multiple conversations and relations it enters into? Systemic therapists informed by psychoanalytic thinking describe a reflective self, responsive to inner conversation about emotional experience ( Flaskas, 2005 ). Those working in mental health services contend with the biological and ‘cognitive‐mindful’ self. Perhaps the self can be defined in many ways or languages as a deconstructive both/and. In this paper the systemic, relational or dialogic self in family therapy is discussed from the perspective of the ethical philosophy of Emmanuel Levinas. For Levinas ethical intersubjectivity is what makes subjectivity and thinking possible. The self is respons‐ibility to other or, as Derrida (1999) says, ‘consciousness is hospitality’ (p. 48). Yet for both Derrida and Levinas the relational self is also a separate and unique self. The ethical self is discussed in relation to family therapy practice.     

A Return to “The Clinic” for Community Psychology: Lessons from a Clinical Ethnography in Urban American Indian Behavioral Health

Community psychology (CP) abandoned the clinic and disengaged from movements for community mental health (CMH) to escape clinical convention and pursue growing aspirations as an independent field of context‐oriented, community‐engaged, and values‐driven research and action. In doing so, however, CP positioned itself on the sidelines of influential contemporary movements that promote potentially harmful, reductionist biomedical narratives in mental health. We advocate for a return to the clinic—the seat of institutional power in mental health—using critical clinic‐based inquiry to open sites for clinical‐community dialogue that can instigate transformative change locally and nationally. To inform such works within the collaborative and emancipatory traditions of CP, we detail a recently completed clinical ethnography and offer “lessons learned” regarding challenges likely to re‐emerge in similar efforts. Conducted with an urban American Indian community behavioral health clinic, this ethnography examined how culture and culture concepts (e.g., cultural competence) shaped clinical practice with socio‐political implications for American Indian peoples and the pursuit of transformative change in CMH. Lessons learned identify exceptional clinicians versed in ecological thinking and contextualist discourses of human suffering as ideal partners for this work; encourage intense contextualization and constraining critique to areas of mutual interest; and support relational approaches to clinic collaborations.     

Career Paths of Eminent Researchers in Marriage and Family Therapy

The mental health field of marriage and family therapy (MFT) needs more MFT researchers and more research to validate and verify the effectiveness and efficacy of MFT for the treatment of various mental health and relational problems. Knowing more about how successful researchers have developed their careers would be useful in both inspiring and guiding young MFT researchers toward success. Three eminent researchers whose careers have focused on MFT (James Alexander, John Gottman, and Howard Liddle) and their publications served as the research sample. Research questions addressing types of research, research samples, research questions, therapy model development, funding, and paths of the research careers were answered using content analysis. Results support guidelines that include having a focused research interest area, adhering to the scientist-practitioner model, obtaining funding, maximizing the utility of research samples, and generating publications.     

The theory of resilience and relational load

Resilience is one of the most profound constructs across disciplines. Yet, the largely atheoretical nature of the research on resilience continues to make it elusive. A new theory of stress and resilience in close relationships—the theory of resilience and relational load (TRRL)—is advanced to fill this void in the literature. The theory bridges communicative, perceptual, and physiological aspects of stress within the context of social relationships to explain personal/relational risk, resilience, and thriving. The TRRL examines how relational partners' and family members' communal orientation and maintenance of their relationships on a daily basis influence their communication during stressful moments, as well as their appraisals of the stress. The theory also details how these communication patterns and appraisals influence personal and relational health and adaptation. Finally, the concept of relational load is set forth, which is the wear and tear that chronic stress and depletion of one's emotional, psychological, and relational resources through repeated, stress‐related conversations can have on relationships. Ultimately, people need to continually invest in their relationships to prevent relational load and foster resilience and possible thriving.     

Family identity and severe mental illness: A thematic synthesis of qualitative studies

There is a growing amount of research showing that a shared social identity and the sense of belonging to a family have a potential effect on health. However, little is known about the effects of severe mental illness on family identity. The authors carried out this thematic synthesis based on a systematic review of literature on family narratives of severe mental illness and family identity. The main findings indicate that in many families (i) their identity—as a shared social identity—undergoes a transformation process by which the identity aspects of being a family are reinforced; (ii) family members often take on a caring role as their main family role; and finally, (iii) a cultural component shapes this transformation process. The authors describe implications for research and application in the mental health field. All in all, family identity is transformed by the experience of severe mental illness.     

Latino Family Participation in Youth Mental Health Services: Treatment Retention,Engagement, and Response

Although researchers have identified a multitude of factors that contribute to family participation in mental health services, few studies have examined them specifically for Latino youth and their families in the U.S., a population that continues to experience significant disparities related to the availability, accessibility, and quality of mental health services. Latino youth and their families are at greater risk of dropping out of treatment prematurely and demonstrating poor treatment engagement, both of which have subsequent negative effects on treatment response outcomes. In order to help to guide efforts to improve the accessibility and quality of mental health services for Latino youth and their families, the current paper integrates modern conceptualization of family participation in youth mental health services and provides a summary of contextual factors within an ecological framework (Bronfenbrenner in The ecology of human development: experiments by nature and design, Harvard University Press, Cambridge, 1979). The current review aims to integrate empirical research on the impact of various contextual factors across multiple levels (i.e., culture, community, mental health system, family, parent/caregiver, and child/adolescent) on Latino family participation in youth mental health services, including treatment retention, engagement, and response. Clinical implications will be discussed, and an integrated, conceptual model will be presented. Not only does this model help to demonstrate the way in which existing literature is conceptually linked, but it also helps to highlight factors and underlying processes that health care providers, administrators, and policy makers must consider in working to improve mental health services for Latino youth and their families living in the U.S.     

How does higher in‐group social value lead to positive mental health? An integrated model of in‐group identification and support

Previous research has indicated that the effects of in‐group social value on mental health are mediated by the extent to which individuals identify with their in‐group. Other research has shown that in‐group identification leads to positive mental health because it provides in‐group members with a psychological basis for social support. We examine how the individual's perception of the social value of the in‐group leads to positive mental health, integrating the effects of identification with and support from the in‐group. As predicted, the relationship between higher social value and decreased mental health (e.g. depression, perceived stressful events) is mediated by higher in‐group identification, which in turn leads the members to expect support from the in‐group but not the out‐group. An integrated model of the effects of perceived in‐group social value, identification, and support on mental health is proposed, and the implications are discussed.     

The effect of relational continuity of care in maternity and child health clinics on parenting self‐efficacy of mothers and fathers with loneliness and depressive symptoms

This study explored the parenting self‐efficacy of the parents of 18‐month‐old children in the context of Finnish maternity and child health clinics. This parenting self‐efficacy was observed in relation with the relational continuity of care and parents' experienced loneliness and depressive symptoms. The relational continuity of care was provided by a public health nurse in maternity and child health clinics. The participating parents were drawn from the STEPS study that is being carried out by the Institute for Child and Youth Research at the University of Turku. The results showed that relational continuity of care provided by the same public health nurse in the maternity and child health clinics was associated with mothers' higher emotional loneliness and with lower scores on three dimensions of parents' parenting self‐efficacy. Loneliness and depressive symptoms negatively influenced parents' parenting self‐efficacy – however, in the case where the family had experienced relational continuity of care, the parents' higher levels of depressive symptoms had not weakened their parenting self‐efficacy beliefs. These results are discussed in terms of organizing maternity and child health clinic services.