Distinguishing Between Conceptualizations of Attachment: Clinical Implications in Marriage and Family Therapy

Authors described four distinct conceptualizations of the construct of attachment and identified clinical implications associated with each. Three of the conceptualizations, which are influenced by the work of Bowlby and Ainsworth, seem to have some empirical support; these conceptualizations are compatible with systemic and social constructionist approaches to family therapy. The other conceptualization— Reactive Attachment Disorder (RAD)—contradicts the extensive body of literature associated with the Bowlby/Ainsworth traditions and tends to pathologize children. Therefore, family therapists interested in attachment are encouraged to maintain conceptual clarity in their clinical work and are further encouraged to rely on clinical conceptualizations and interventions that are consistent with the work of Bowlby and Ainsworth.     

Associations Between Attachment Narratives and Self-Report Measures of Attachment in Middle Childhood: Extending Evidence for the Validity of the Child Attachment Interview

The assessment of attachment security in infancy and adulthood is well-studied, but middle childhood has been relatively neglected in the literature. The Child Attachment Interview (CAI) represents a promising assessment of attachment in middle childhood; recent evidence supports its reliability and validity in restricted samples. We assessed the construct validity of the CAI among a diverse sample of 104 8–12 year-old children (M _age  = 9.80 years; 50 boys; 49 % family income <$40,000; 38 % Latino/a). We evaluated associations among CAI variables and self-report measures of attachment (convergent validity). Further, we evaluated whether CAI variables uniquely relate to theoretically-relevant constructs (internalizing symptoms) above and beyond self-reported attachment (incremental validity) and a theoretically-distinct construct, child temperament (discriminant validity). Our findings support the CAI’s validity, and have important implications for assessing and understanding attachment processes in middle childhood, as well as their development across the lifespan.     

Development of Family Therapy and Systemic Therapy in Germany

The roots of systemic therapy in Germany date back to the sixties. Systemic therapy is one of the most widely applied forms of psychotherapy and counseling in Germany. The majority of therapists and counselors in child guidance centers, couples therapy counseling centers and youth protective services have been trained in systemic therapy. A high number of clinical psychologists, social workers and medical doctors have received training in this model of therapy. In the beginning, multigenerational, experiential, as well as structural-strategic and Milan systemic approaches were popular. Today, the post-modern systems concepts, solution-oriented and narrative approaches and self-organization theory appear to be predominant. Some centers provide research and training in behavioral and psychodynamic family and couples therapy. However, systemic approaches are clearly leading the field with over 10,000 people who have received systemic training and about 150 training institutes across the country. The critical attitude shared by many leading figures towards empirical research has limited its success in university programs. In addition, training is usually provided in the form of post-graduate courses rather than at academic institutions. Currently, three journals and one online-journal publish articles on various systemic topics. Many publishing houses have a series of books on systemic therapy and one publishing house specializes exclusively on systems oriented books. In 2008, systemic therapy gained recognition as an evidence-based treatment. Four years later, the appropriate authorities have not initiated the process of assessing it as a treatment paid for by public health insurances. In consequence, systemic therapy is not available on a large scale in the public outpatient psychotherapy system. Some additional remarks are provided on the history and current situation of systemic therapy in Austria and Switzerland.     

Systemic Family Therapy in Greece: Polyphony and Diversity

The paper aims at presenting the state of the art regarding systemic/family therapy in Greece, in relation to practice, professional and accreditation issues and training. It is argued that systemic/family therapy in Greece constitutes a lively and diverse terrain with roots in the 1960s and a rapid dissemination of the approach following the mid 1980s. The field’s development in Greece is out-sketched by means of ‘data’ collected from a variety of sources, like web sites of associations and training centers, published articles and informal and semi-structured interviews conducted with seminal figures. First, a concise historical overview of the birth of systemic/family therapy is presented in relation to the wider socio-political context and the attempt for the reform of the psychiatric system in Greece during the 1980s. Second, a brief sketch of the existing associations as well as of the contexts where systemic/family therapy is practiced is outlined in relation to issues regarding accreditation and statutory regulations. Third, a non-exhaustive list of currently existing training programs is reviewed in respect of axis, like their content and structure, accreditation issues, entry requirements, etc. The paper concludes with inferences regarding the existing state of the art including future potential directions, whilst hinting to research ventures, which could enrich our understanding of both the history and the potential of the field in the Greek context.     

Non-Normative Systemic Therapy in a Case of Intergenerational Enmeshment

There are a number of differences between normative and non-normative systemic therapy. It is useful to understand normative thinking because that is a traditional orientation. Non-normative clinical work also has much to offer both philosophically and practically: It is characterized by the premise that people's behavior makes sense given their histories and current context. Therefore, when understood from the perspective of the individual, even his or her psychopathology would make sense. Using a composite case analyzed in normative terms and treated non-normatively, the author illustrates how to bridge these two approaches. Solution-focused methods constitute the interventions of choice.     

Family Therapy Techniques in Residential Settings: Family Sculptures and Reflecting Teams

Outcome data has shown that family therapy is highly effective in the treatment of many disorders including addiction, mood, and other issues. In working to make treatment as effective as possible, many residential treatment and outdoor behavioral healthcare (OBH) programs have adopted family therapy techniques for use in individual and peer group therapy settings. Some have also incorporated family members by inviting them to visit the residential setting and participate in treatment exercises. An article by Faddis and Bettmann (J Ther Sch Program 1(1): 57–69, 2006) outlines an example of this integrated approach to family sculptures and reflecting teams in a wilderness therapy setting for adolescents. This integrated technique has since come to be known as the four phase Familial Sculpting and Reflecting intervention. Most recently these methods have been expanded for use with young men ages 18–30 in an adventure wilderness therapy program. This article will examine the theoretical basis for both of these approaches, discuss the application of these techniques to residential OBH programs and review how these methods have been most recently adapted for use in another program.     

Research and Reflection: Animal‐Assisted Therapy in Mental Health Settings

Although animals have been historically associated with promoting physical and mental health benefits for humans, only recently has there been support for such claims in the literature. This article is a preliminary attempt to bring together scientific studies and anecdotal reports that provide evidence of the benefits of using animals in particular counseling situations.     

Creating a Secure Family Base: Some Implications of Attachment Theory for Family Therapy

The aim of this article is to make attachment research findings available in a form that family therapists can use. In attachment theory, parents are conceptualized as providing a secure base from which a child can explore. Family therapists, however, need a systemic concept that goes beyond the parent/child dyad. The concept of a secure family base is proposed, in which a network of care is made available for all family members of whatever age so that all family members feel secure enough to explore, in the knowledge that support is available if needed. Factors that contribute to the security or insecurity of the family base are outlined. The overall aim of therapy is to establish a secure family base from which the family can explore new solutions to family problems both during and after therapy. The role of the therapist is to help to resolve conflicts that threaten relationships, and to explore relevant belief systems that may be contributing to a sense of insecurity. The conceptual framework presented allows for an integration of family therapy techniques and ideas into a coherent whole. A new school of family therapy is not proposed.     

Marital Therapy and Marital Power: Constructing Narratives of Sharing Relational and Positional Power

Scholars continue to emphasize in their conceptualizations of marital power the capacity to exert influence in the marital relationship based on the control of valued resources and status (positional power). Much less attention has been given to the capacity to exert authority in the marital relationship through the context of an intimate relationship and the opportunities for influence it provides (relational power). Strategies are suggested for co-authoring narratives with couples in the process of therapy that create opportunities for them to share these bases of power within their families in ways that free them from the negative constraints associated with cultural discourses about gender and power.     

Using Client Narratives to Identify Predictors of Outcome in Written Exposure Therapy and Cognitive Processing Therapy

Written exposure therapy (WET) is a brief, five-session treatment for posttraumatic stress disorder (PTSD) that aims to improve access to care. WET has been demonstrated to be an efficacious PTSD treatment with lower rates of dropout and noninferior PTSD symptom outcome compared to cognitive processing therapy (CPT), a 12-session, gold-standard treatment. To identify predictors of treatment outcome in both WET and CPT, the current study examined the content of participants’ written narratives. Participants were 123 adults with PTSD who were randomly assigned to receive WET (n = 61) or CPT (n = 62). The Change and Growth Experiences Scale (CHANGE) coding system was used to code all available narratives in both treatment conditions for variables hypothesized to be relevant to therapeutic change. Linear regression analyses revealed that in WET, higher average levels of accommodated (healthy, balanced) beliefs and an increase in accommodated beliefs from the first to the final impact statement predicted better PTSD symptom outcome at 12 weeks postrandomization. In CPT, higher average levels of overgeneralized and accommodated beliefs and lower levels of avoidance expressed in the narratives predicted better PTSD outcome. There were no significant predictors of outcome in analyses of change from the first to final impact statement in CPT. These findings add to research identifying predictors of change in WET and CPT by highlighting the importance of low avoidance in CPT and of trauma-related cognitions in both CPT and WET, even though WET is a brief written intervention that does not explicitly target cognitive change.     

Primary Care and Clinical Psychology: Assessment Strategies in Medical Settings

There is ample evidence regarding medical-psychological comorbidity to consider clinical psychology as a viable component of health care services in medical settings. Psychologists can become valuable assets to primary care physicians who treat a high number of primary psychiatric cases as well as medical cases with secondary psychological symptoms. Psychologists who function in hospital-based clinics as well as affiliates with primary care (PC) offices can provide empirically supported assessment services that can make treatment more effective and efficient. Multiple studies indicate high prevalence rates of psychiatric patients in PC settings using various instruments. This paper reviews selected assessment tools that have established diagnostic validity and reliability that can be both strategic for patient care and useful to reinforce psychologist collaboration with primary care physicians (PCP).     

Immigration as a Dynamic Experience: Personal Narratives and Clinical Implications for Family Therapists

This is a reflective account of the experiences of the authors who immigrated to the United States from India at different developmental, historical, political, and social stages. Although their culture-of-origin was the same, the meaning and experience of immigration was different for each author. The narratives show a natural continuum of experiences based on their developmental stage during immigration, reasons for immigration, and the historical context of both India and the US at the time of immigration. A common theme is the ambivalence experienced by them in their process of creating a physical and psychological home in a different culture.     

Commentary on Guild et al. (2020): The Importance of Well-Designed Intervention Studies for Advancing Attachment Theory and its Clinical Applications

Research on Child and Adolescent Psychopathology - Guild and colleagues (this issue) report results of a long-term follow up after a randomized trial of the effectiveness of an...     

Early Termination from Couple Therapy in a Naturalistic Setting: The Role of Therapeutic Mandates and Romantic Attachment

Drawing on a series of 141 couple therapy cases, the main goal of the present study was to determine whether romantic attachment, pre-treatment relationship distress and therapeutic mandates (i.e., reduction of couple distress or ambivalence resolution) are prognostic indicators of early termination. Couples completed the Dyadic Adjustment Scale (Spanier 1976) and the Experiences in Close Relationships Questionnaire (Brennan et al. 1998) at intake, whereas therapists filled in the Classification of Therapeutic Mandates (Poitras-Wright and St-Père 2004) after the 4th session. Results showed that an ambivalence resolution mandate, elevated couple distress and higher levels of attachment anxiety were associated with early termination. The implications of these findings to further understand early termination in couple therapy are discussed.