The reliability and validity of a system for family assessment

The Darlington Family Assessment System (DFAS) is based upon the principles of multisystem-multimethod (MSMM) assessment. In practice it consists of a structured family interview with an integrated rating scale, a number of self-report questionnaries, and a task with an integrated behaviour coding system. This article summarizes the results of a series of empirical evaluations of the DFAS, which concern evaluations of the system as an aid to clinical work with families and as a method for training (at a basic level) in family assessment. The results are presented in terms of their implications for the reliability and validity of the assessment system and discussed from the perspective of their generalizability.     

Anger Management

Many occupational therapy techniques and theories addressing anger have been incluenced by general misconceptions about anger within the field of psychology and the general public. Until occupational therapists develop a unique perspective for defining anger and understanding how anger affects one's ability to function in one's occupational roles, they will continue to depend upon other professions to provide information on addressing anger problems. Part one of this two-part series on anger management formulates a construct of normal anger pertinent to occupational therapy practice and identifies complexities and misconceptions which have obscured the nature of anger. The second article presents basic concepts of anger management and mismanagement, provides clinical applications of these concepts, and delineates how anger affects human occupation. To accomplish this purpose, the Model of Human Occupation was used as a framework for integrating information on anger from the social sciences into a perspective of anger useful for the occupational therapist.     

Closing the gaps: developmental psychopathology as a training model for clinical child psychology

Espouses developmental psychopathology as a framework for training our future leaders due to its emphasis on an ecological, transactional lifespan perspective, as well as interdisciplinary bridging and policy focus. This perspective, used as a framework for questioning and thinking about the complex interplay of psychological and social phenomena, provides a method for closing the gaps in training future psychologists as it allows for the development of niche expertise under an umbrella of the broader, ecological perspective. In an increasingly complex world of shrinking mental health dollars and growing severity of mental health problems for families and youth, clinical psychologists are needed more than ever to solve social problems. The current training paradigms in clinical child psychology programs need redirection and clarification for future psychologists to contribute meaningfully to science, practice, and policy. This article provides background in the history and influence of the developmental psychopathology perspective, as well as future implications for doctoral training programs in clinical psychology.     

Family therapy ‘lite’? How family counsellors conceptualise their primary care family work

A number of current developments in the field potentially provide opportunities for preventative relationship and family interventions to be integrated into primary care. In this context, it is important to understand what family counselling is and how it might differ from family therapy. Thus, this paper investigates how the service of one low-intensity family counselling provider, Relate, is conceptualised and practised by counsellors on the ground. Questions about practice were posed to five focus groups of family counsellors and these were analysed using thematic analysis. The findings suggest that Relate family counselling is seen as ‘family therapy lite’, with a flexible, eclectic and integrative use of concepts and techniques within a systemic framework. Implications of this conceptualisation of family counselling for training, practice and research are discussed.     

A model to coordinate understanding of active autonomous learning

Family therapy has enthusiastically taken up certain concepts for adult education but has not benefited from the full range of ideas that are now both available and compatible with current epistemologies. Good practice in formulating learning objectives is discussed and the objectives of this article are specified. Areas of psychology that are relevant to adult learning are reviewed, and concepts of adult education that are important in the training of family therapists are considered. A model of a spiral process of learning that has been developed within the Leeds Family Therapy and Research Centre is proposed. The model coordinates the principles of adult learning described in the article and may be used as a framework for considering whether training will achieve its learning objectives as well as allowing people engaged in learning to gain further insight into how they learn. Readers are encouraged to use the principles of active reflective learning during their processing of the article.     

Barriers and challenges in the practice of multicultural counselling in Malaysia: A qualitative interview study

Counsellors face a lot of problems and stressors in their daily lives. As a person, counsellors may face challenges to deal with their personal expectations and responsibilities in life, work, family and community. As a professional, counsellors may face difficulties in dealing with professional issues and ethical dilemmas in their professional practice such as countertransference and value conflicts. These raise issues concerning their perceived multicultural competence and the adequacy of their training. Informed by a multicultural counselling perspective and drawing on semi-structured interviews with 12 professional counsellors in Malaysia, this study discusses the types of barriers and challenges faced by Malaysian counsellors and how these challenges were manifested and addressed in the cross-cultural counselling sessions. Results revealed five emerging themes based on participant counsellors’ responses on the barriers and challenges encountered in their practice of multicultural counselling in Malaysia. These were challenges related to counsellors’, clients’, presenting issues’, third-party and specific contexts’ characteristics. Research implications for the education and training of counsellors in the specific Malaysian socio-political context are also discussed.     

The Role Change Assessment

Occupational role performance is a key concept of occupational therapy theory and practice. The Role Change Assessment was developed to facilitate the systematic evaluation of the rolc performance of older adults. It uses a semi-structured interview format to examine 48 roles in family and social, vocational, self-care. organizational, leisure, and health care categories. This article describes the need for and development of the instrument and illustratcs its use through case reports.     

Stories of crime,stories of suffering: A narrative perspective on ethical issues in criminal justice counselling

Counsellors working with prisoners often listen to stories that are both stories of crime and stories of suffering. From a criminal justice perspective, the suffering of offenders is deliberately inflicted as punishment. From a counselling perspective, however, responding to the suffering of a client and even trying to relieve it is a basic ethical concern. So counsellors, working with offenders, may face the ethical question of how to integrate a response to the suffering of offenders with a response to crime, especially when confronted with stories of cruel, violent crimes. In this paper, it is argued that a narrative perspective on counselling offers a framework in which these responses may be integrated. Here, the principle of recognizing privileged authorship of persons is crucial. The concepts of ‘double listening for implicit others’ and ‘relationally rich stories’ are developed, which are based on concepts and ideas from narrative therapy. These serve as a first step of translating the narrative ethical framework to counselling practice.     

Patient‐focused research supported practices in an intensive family therapy unit

The aim of this study is to explain how families evaluate and describe the use of two measures, the session rating scale and the outcome rating scale, in order to monitor therapeutic work. This study is methodologically based on modifications of methodical hermeneutics and consensual qualitative research. The results confirm the feasibility of these scales although some difficulties were identified. The analysis of the family interviews identified four conversational processes: communicating, focusing, structuring and exploration. These arise through the application of the scales, indicating their usefulness as conversational tools. In general, it is suggested that all the measurements and tools applied can be seen as therapeutic tools that are especially useful for establishing conversations and strengthening collaboration between service users and therapists. This brings the practice of monitoring therapeutic work into close contact with postmodern‐oriented forms of therapy.     

An extension of the rating scale model with an application to the measurement of change

The polytomous unidimensional Rasch model with equidistant scoring, also known as the rating scale model, is extended in such a way that the item parameters are linearly decomposed into certain basic parameters. The extended model is denoted as the linear rating scale model (LRSM). A conditional maximum likelihood estimation procedure and a likelihood-ratio test of hypotheses within the framework of the LRSM are presented. Since the LRSM is a generalization of both the dichotomous Rasch model and the rating scale model, the present algorithm is suited for conditional maximum likelihood estimation in these submodels as well. The practicality of the conditional method is demonstrated by means of a dichotomous Rasch example with 100 items, of a rating scale example with 30 items and 5 categories, and in the light of an empirical application to the measurement of treatment effects in a clinical study.Work supported in part by the Fonds zur Förderung der Wissenschaftlichen Forschung under Grant No. P6414.     

Operating characteristic analysis of attribute ratings

The analysis of receiver operating characteristics as employed in psychophysics is suggested as a way of obtaining several useful measures in the context of attribute ratings. These include the difference between two stimuli on the attribute, the tendency for Ss to favor one pole of the rating scale, width of rating categories, and equal interval properties of the rating scale. The underlying measurement model is described along with means of evaluating its basic assumptions.     

A Framework and Themes for Social Network Intervention

This paper is concerned with the development and application of social network concepts in clinical practice. A framework of network levels and sets for ordering data and observations is proposed; the phenomenon of truncated networks is considered and two emphases in network intervention (gathering and connecting forms) are proposed to conceptualize network characteristics and practice that follows from such characteristics. A number of current examples of network practice are placed within the framework, and several advantages of utilizing a network perspective as a complement to existing models of family therapy are noted.     

Employers' Perceptions of Occupational Therapy in Community Mental Health

ABSTRACT

This paper explores the nature of occupational therapy practice from the perspective of community mental health agency directors currently employing occupational therapists. Directors were interviewed using a semi-structured format. Retrospective content analysis produced a systematic detailed summary of six major and eight minor themes separating into process themes or how the occupational therapist practised, and content themes, or what the occupational therapist practised. The process themes included a holistic approach, client centredness, and a practical, outcome oriented focus. The content themes included the use of activity, focus on individual functioning, and specific vocational and living skill training. In addition, some directors identified inadequacies including insufficient medical background and the need for education in community practice. Themes were compared against two additional data sources; expert occupational therapists and current literature in occupational therapy in mental health. There was agreement on the major themes. Implications of these results are discussed.     

Family Systems: Morphostasis and Morphogenesis,or “Is Homeostasis Enough?”

The role of family homeostasis in Conjoint Family Therapy is reviewed and examined from the standpoint of the Sociocultural Systems framework as presented by Buckley. Sociocultural Systems concepts are presented, and an attempt is made to relate them to a view of the family. It is concluded that the concept of homeostasis by itself is insufficient as a basic explanatory principle for family systems and that it may limit both our expectations for families and our approaches to helping families. The concepts viability, positive feedback processes, morphogenesis, and "variety" are presented and emphasized as important for a more tenable conceptualization of the family system in our society today. An attempt is made to relate these concepts to some of the clinical family literature and to examine the implications of these concepts for mental health and educational approaches to the family.     

Chaos and Change in a Suicidal Family

Chaos theory is an important paradigm shift in science that has significant implications for psychological theory and psychotherapy. The concepts evolving from chaos theory can help clinicians identify patterns in family interactions that are critical if transformations are to occur. This article explores a specific case example from the perspective of chaos theory. Observing how suicidal behavior becomes part of a pattern of family interaction may offer a framework for clinicians to observe the dynamics of chaos.     

Techniques of Structural Family Assessment: A Qualitative Analysis of How Experts Promote a Systemic Perspective

The trajectory of assessment in structural family therapy moves from a linear perspective, in which problems are located in the identified patient, to an interactional perspective, in which problems are seen as involving other members of the family. Minuchin, Nichols, & Lee (2007) developed a 4‐step model for assessing couples and families consisting of: (1) broadening the definition of the presenting complaint to include its context, (2) identifying problem‐maintaining interactions, (3) a structurally focused exploration of the past, and (4) developing a shared vision of pathways to change. To study how experts actually implement this model, judges coded video recordings of 10 initial consultations conducted by three widely recognized structural family therapists. Qualitative analyses identified 25 distinct techniques that these clinicians used to challenge linear thinking and move families toward a systemic understanding of their problems. We discuss and locate these techniques in the framework of the 4‐step model.     

The common sense of counseling psychology: introducing the Common-Sense Model of self-regulation

Abstract

The goal of therapy is typically to improve clients’ self-management of their problems, not only during the course of therapy but also after therapy ends. Although it seems obvious that therapists are interested in improving clients’ self-management, the psychotherapy literature has little to say on the topic. This article introduces Leventhal’s Common-Sense Model of Self-Regulation, a theoretical model of the self-management of health, and applies the model to the therapeutic process. The Common-Sense Model proposes that people develop illness representations of health threats and these illness representations guide self-management. The model has primarily been used to understand how people self-manage physical health problems, we suggest it may also be useful to understand self-management of mental health problems. The Common-Sense Model’s strengths-based perspective is a natural fit for the work of counseling psychologists. The model has important practical implications for addressing how clients understand mental health problems over the course of treatment and self-manage these problems during and after treatment.