What Does it Mean to be a Common Factors Informed Family Therapist?

The common factors paradigm in couple and family therapy has gained popularity over the past several decades, leading many therapists to refer to themselves as common factors family therapists. Despite this, no consensus exists on what it means to be a common factors family therapist, or if such a designation even makes sense given that the common factors paradigm is not a model. Synthesizing the existing common factors literature, a case is made for the designation “common factors informed family therapist,” and the following six core principles are outlined that characterize this designation: (1) sees overlap among theories; (2) passionate about theory, not a theory; (3) client centered; (4) monitors hope and the therapeutic alliance; (5) views clients as people rather than objects; and (6) prioritizes healing over therapy. Each of the concepts is discussed in depth, and clinical implications are provided.     

THE PROBLEM OF “GOD” IN PSYCHOLOGY OF RELIGION: LONERGAN'S “COMMON SENSE” (RELIGION) VERSUS “THEORY” (THEOLOGY)

The emphasis on God in American psychology of religion generates the problem of explaining divine‐versus‐natural causality in “spiritual experiences.” Especially “theistic psychology” champions divine involvement. However, its argument exposes a methodological error: to pit popular religious opinions against technical scientific conclusions. Countering such homogenizing “postmodern agnosticism,” Bernard Lonergan explained these two as different modes of thinking: “common sense” and “theory”—which resolves the problem: When theoretical science is matched with theoretical theology, “the God‐hypothesis” explains the existence of things whereas science explains their natures; and, barring miracles, God is irrelevant to natural science. A review of the field shows that the problem is pervasive; attention to “miracles”—popularly so‐named versus technically—focuses the claims of divine‐versus‐natural causality; and specifications of the meaning of spiritual, spirituality, science, worldview, and meaning itself (suffering that same ambiguity: personal import versus cognitive content) offer further clarity. The problem is not naturalism versus theism, but commonsensical versus theoretical thinking. This solution demands “hard” social science.     

Influence of Racial/Ethnic Membership and “Therapist Culture” on Therapists' Worldview

The authors investigated 2 competing hypotheses related to therapists' worldview and therapists' race/ethnicity: (a) whether therapists of different racial/ethnic groups differed on worldview reflecting group membership, and (b) whether therapists were similar to each other on worldview reflecting membership in a “therapist culture.” Results indicated that therapists shared similar worldviews regardless of group membership, and differences found between therapists based on racial/ethnic membership were minimal.     

Salivating,and Thinking in Different Languages

This study investigated age, sex, and title of therapist as determinants of patients' preferences. In general it was found that (a) “psychologists” and “psychiatrists” were preferred to “behavioral consultants,” “emotional counselors,” and “psychoanalysts” who, in turn, were preferred to “social workers”; (b) male therapists were preferred to female therapists; and (c) 40-year-old therapists were preferred to 55-year-old therapists who, in turn, were preferred to 25-year-old therapists.     

Engaging “Resistant” Families in Treatment

Many families, when presented with the option of family therapy, are less than eager to participate. This paper comprises the second and third parts of a series on engaging “resistant” families. ¹ 1 The first paper in this series, authored by J. M. Van Deusen, M. D. Stanton, S. M. Scott, and T. C. Todd, is entitled “Engaging “Resistant” Families in Treatment: I. Getting the Drug Addict to Recruit His Family Members” and appeared in the International Journal of the Addictions 15 (7): 1069–1089, 1980. A revised and expanded version of Part II is presented in M.D. Stanton, T. C. Todd, and Associates, The Family Therapy of Drug Abuse and Addictions New York, Guilford, in press.
Part II presents 21 principles and a number of techniques and strategies that have been developed for successfuly recruiting such families. These techniques should be applicable for engaging resistant families with all types of presenting problems. Part III provides an analysis of the important variables involved, along with data on cost efficiency and administrative costs. It was found that when therapists had administrative control of their cases, serving in dual roles as both therapists and drug counselors, the recruitment effort was (a) more effective (i.e., complete families, including both parents or parent surrogates, were recruited in 77 per cent of the cases), and (b) twice as cost efficient. Two-thirds of the non-engaged families were not recruited because the index patient would not allow family members to be contacted. Black families were more difficult to recruit than whites. Data on cost efficiency and on the actual administrative costs of recruiting families are also provided. We conclude that the engagement process requires a revision in therapeutic philosophy, since such families are often desperately in need of help but are unavailable unless therapists make a special effort to reach them.     

What do psychodynamic therapists make of their reveries in the therapeutic encounter? A constructivist grounded theory study

ABSTRACT

The therapist’s mind can wander to daydreams, fantasies and preoccupations: mental events termed “reveries” in this study. As therapists attend to the current of their thought in the therapeutic encounter, the question of how to approach their reveries can arise. This qualitative study used semi-structured interviews with nine qualified psychodynamic therapists to investigate therapists’ attitudes to reveries. The research design and analysis followed the principles of Charmaz’s [Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage; Charmaz, K. (2014). Constructing grounded theory (2nd ed.). London: Sage] constructivist grounded theory. Results showed that therapists experienced diverse reveries sometimes felt to yield deeper clinical understanding. Reveries were also seen to have a “freeing-up” function for the therapist and patient, and to require mental freedom to operate. Implications for theoretical understanding and recommendations for clinical technique are discussed.     

Perceptions of the Limitations of Confidentiality Among Chinese Mental Health Practitioners,Adolescents and Their Parents

The present study aims to (a) survey Chinese mental health professionals’ attitudes toward therapeutic confidentiality with adolescent patients in specific clinical situations, and (b) compare Chinese adolescents’ and parents’ beliefs about when most mental health professionals would breach confidentiality. A sample of 36 mental health practitioners, 152 parents, and 164 adolescents completed a survey to assess their opinions about when confidentiality should be breached in 18 specific clinical situations (e.g., an adolescent tells his or her therapist that he or she smoked a cigarette, had unprotected sex, or attempted suicide). Nearly half of the parents (46%) and adolescents (41%) and 78% of the therapists in our sample selected “yes” in response to the question of whether the principle of confidentiality applies to adolescents. However, 49% of parents indicated “no,” and 53% of adolescents indicated “not sure.” Compared to adolescents, parents were significantly more likely to believe that therapists would breach confidentiality for the high-breach-likelihood items. For the low-breach-likelihood items, adolescents and parents were significantly more likely than therapists to believe confidentiality should be breached. Results from this study provide data to inform the development, refinement, practical implementation, and communication of guidelines and recommendations specific to adolescents receiving psychotherapy in China.     

The effects of therapist-client age similarity on pretherapy expectations

The present study investigated the effects of similarity between psychotherapist age and client age on client's preference for a therapist, willingness to disclose, expected therapeutic climate, and perceptions of therapist competence. Similarity theory provided a rationale for the hypothesis that prospective clients would perceive a psychotherapist similar in age more favorably than a therapist dissimilar in age. Support for the hypothesis was obtained on the dimensions of client preference, willingness to disclose, and therapist competence. Also, consistent with previous research, high experienced therapists were viewed more favorably than low experienced therapists.This research is based on a doctoral dissertation submitted by Kathleen M. Tall under the direction of Michael J. Ross to Saint Louis University.     

Not starting psychotherapy is more often initiated by the therapist than the patient

The phenomenon of not starting psychotherapy is seldom investigated. The present study of psychotherapy in the Swedish mental health services differentiates between patients applying for and being offered psychotherapy but choosing not to start (n = 69), patients recommended to receive no treatment, another type of treatment or treatment at another clinic (n = 133), and therapy starters (n = 1294). After the initial assessment, nearly twice as many patients did not start based on the therapist’s decision than on the patient’s. Cases of not starting psychotherapy decided by the therapist were more frequent among patients whose occupational status was less stable, presented a danger to others, had lower levels of initial therapeutic alliance, and by therapists with lower levels of psychotherapy training and those at less structured and more unstable clinics. Patients choosing not to start therapy had lower levels of mental ill-health than both starters and therapist-initiated nonstarters. The most frequently presented reason for a patient-initiated decision to not start therapy was “patient wished another treatment or therapist,” whereas the most common therapist-initiated reason was “recommended or referred to another treatment or clinic”.     

A preliminary examination of the role of psychotherapist fidelity on outcomes of cognitive processing therapy during an RCT for military sexual trauma-related PTSD

While cognitive processing therapy (CPT) is an effective evidence-based treatment for many veterans with military-related post-traumatic stress disorder (PTSD), not all veterans experience therapeutic benefit. To account for the discrepancy in outcomes, researchers have investigated patient- and research design-related factors; however, therapist factors (e.g. fidelity) have received less attention. The present study is a preliminary examination of the effect of psychotherapists’ fidelity during CPT on clinical outcomes during a randomized clinical trial (RCT) for military sexual trauma-related PTSD. PTSD symptoms, trauma-related negative cognitions (NCs), and depression symptoms were assessed for 72 participants at baseline, and 1-week, 2-month, 4-month, and 6-month posttreatment. Of the four CPT therapists, two were found to have significantly poorer (i.e. “below average”) treatment fidelity scores compared to the other two therapists who had “good” treatment fidelity scores. To examine possible therapist effects on outcomes, hierarchical linear modeling was utilized with therapist fidelity entered as a Level 2 predictor. Participants treated by a therapist with “good” treatment fidelity experienced significantly greater reductions in PTSD symptoms, NCs, and depression symptoms than patients treated by a therapist with “below average” treatment fidelity. Our preliminary findings highlight the importance of monitoring, maintaining, and reporting fidelity in psychotherapy treatment RCTs.     

Couples' Experience of Enactments and Softening in Marital Therapy 1

Abstract

Beginning therapists are not prepared to deal with the complexity that families bring to the therapeutic setting and have a reductionistic approach to understanding what is occurring in a family. In order to move beyond a simplified approach, therapists with the assistance of a supervisor have the power to leave the security of their own being and can learn to take risks. This paper explores the development of a “therapeutic story” with the goal of assisting the beginning therapist in approaches that can be utilized to incorporate all available resources that will help to empower a family to change.     

McCandless's Response to “Soul Healing: A Model of Feminist Therapy”

The term soul healing captures the reader's imagination by intimating that therapy may do more than just focus on the healing of emotional pain. The author of “Soul Healing: A Model of Feminist Therapy,” Patricia M. Berliner, a psychologist, therapist, and sister of St. Joseph (Brentwood, New York) is to be applauded for recognizing the need for a model of therapy that consciously intends to address the concerns of women “who value the spiritual dimension in their lives” (p. 2).     

Why Do We Still Call Them “Paradoxes”

The fact that therapists label some events “paradoxical” may suggest that our current beliefs or theories are limited in their ability to adequately account for those phenomena. It is argued that our underlying belief in objectivity surrounds therapeutic “paradoxes” with a persistently paradoxical aura, and leads to confusion in our understanding of a variety of phenomena. Maturana's ideas regarding structure determinism, instructive interaction, and phenomenal domains are used to suggest an answer to these difficulties. It is claimed that the problematic status of many theoretical concepts (for example, communication, information, resistance, homeostasis, and pathology) is revealing of something quite important — that the experiential validity of instructive interaction repeatedly leads us into implicitly or explicitly employing instructive interaction in a domain where it can never be valid: the domain of theory and explanation.     

“I’ve got you under my skin”: Relational therapists’ experiences of patients who occupy their inner world

The aim of this study was to conduct an in-depth exploration of therapists’ experiences of patients who affect them more than others and occupy their inner world beyond the context of therapy sessions. A phenomenological analysis was performed on semi-structured interviews with five relational therapists. All the therapists had a strong experience of a particular patient getting “under their skin.” In all these cases, the patient was a traumatized woman. The distinctive characteristic of the phenomenon was a sense of blurred or too permeable boundaries between the therapist and the patient. This was associated with fear and anxiety, but also with feelings of love. The therapists’ reactions to having a patient “under their skin” varied from resistance to symbiotic relatedness. The therapists’ ideas of their professional role influenced how the experience of carrying the patient’s suffering was interpreted. The phenomenon of the patient’s presence in the therapist’s representational world might be interpreted as a distinct countertransference phenomenon when working in a more “thin boundary” manner with particular cases. The therapists’ ability to effectively manage their vulnerabilities, activated in the countertransference, seems to be crucial for therapeutic progress. Implications for research, clinical practice, and training are discussed.     

Therapy with Refugee Families: What Is a “Good” Conversation?

This article addresses the question of what is a “good” conversation by analyzing “poor” conversations. During a project on family therapy with refugee families, we often experienced what we labeled as “poor” conversations. We present examples of a variety of such conversations, which we then analyze with reference to therapeutic maps and central concerns of the therapists. We describe four patterns of therapist/client relationships that emerged from this analysis. The main focus of our discussion is to clarify when “poor” conversations may be an important part of the therapeutic process, and when and how they should be avoided. We believe that the issues we raise are central to therapeutic work in general and not just to therapy with refugee families.     

Therapeutic Relationships Re-Defined

Abstract

The therapeutic relationship has traditionally been central to occupational therapy. This study surveyed 129 practicing occupational therapists in Connecticut, concerning how they define and use the therapeutic relationship with clients in today's cost-conscious health care environment. The following four hypotheses: (1) Therapeutic relationships are related to functional outcome, (2) Definitions of therapeutic relationships include words and phrases expressed in the literature and by experts, (3) There are differences in perceptions of therapeutic relationships among pediatric, adult, and geriatric specialty subgroups, (4) Most occupational therapists learned skills in developing therapeutic relationships “on the job,” rather than during professional education, were all supported. This study reaffirms the importance of the therapeutic relationship in occupational therapy practice and provides an updated definition: A trusting connection and rapport established between therapist and client through collaboration, communication, therapist empathy and mutual understanding and respect.     

The Powerless Therapist and the Helpless Borderline: Acceptance,Aloneness, and Dyadic Joining

The encounter between therapist and borderline patient brings with it a humbling experience of powerlessness. The therapist or helping agent must confront her or his own feelings of inability to change anything in the patient's mental or material life. With this comes a corresponding reality that the locus of therapeutic action remains very circumscribed indeed. Many therapists, particularly new ones to the field, may feel overwhelmed by anxiety, grief, guilt, and fear, tempting them to jump precipitously into interpretations or thinly veiled advice-giving—or, alternatively, to deflect emotion with hollow “empathic” mirroring. By actively getting in touch with and using his or her experience of powerlessness, however, the therapist can find a way forward that relies on dyadic joining and a more useful conception of the therapist/patient system (whose dynamics, as we will see, are also increasingly clarified thanks to emergent neuroscience findings). Central aspects of this approach have been present since borderline first appeared in the literature, continuing through more recent contributions, notably those of Marsha Linehan and the Dialectical Behavior Therapy (DBT) school.     

THE “AS‐YET SITUATION” IN WINNICOTT'S “FRAGMENT OF AN ANALYSIS”: YOUR FATHER “NEVER DID YOU THE HONOR OF”… YET

The author proposes a new hypothesis in relation to Winnicott's “Fragment of an Analysis”: that as early as 1955, in the case described in this text, Winnicott is creating the paternal function in his patient's psychic functioning by implicitly linking his interpretations regarding the father to the Freudian concept of Nachträglichkeit. The author introduces an original clinical concept, the as‐yet situation, which she has observed in her own clinical work, as well as in Winnicott's analysis of the patient described in “Fragment of an Analysis” (1955).     

“I am NN”: A Reconstruction of Anscombe's “The First Person”

This paper develops a way of understanding G. E. M. Anscombe's essay “The First Person” at the heart of which are the following two ideas: first, that the point of her essay is to show that it is not possible for anyone to understand what they express with “I” as an Art des Gegebenseins—a way of thinking of an object that constitutes identifying knowledge of which object is being thought of; and second, that the argument through which her essay seeks to show this is itself first personal in character. Understanding Anscombe's essay in this light has the merit of showing much of what it says to be correct. But it sets us the task of saying what it is that we understand ourselves to express with “I” if not an Art des Gegebenseins, and in particular what it is that we understand ourselves to express with sentences with “I” as subject that might seem to express identity judgments, such as “I am NN”, and “I am this body”.