Influence of Therapist Behaviors on Therapeutic Alliance

A number of recent studies have investigated the relationship between therapist and client gender and conversation in marriage and family therapy. There has also been recent empirical investigation of therapeutic alliance and its influence on therapy outcome in marriage and family therapy. However, there has been limited investigation of the influence of interactional patterns on therapeutic alliance. It seems probable that therapy conversation (which seems to be influenced by gender) will influence therapeutic alliance and subsequent outcome.     

Therapist and Family Values in a Cultural Context

In this article the author discusses the nature, complexity, meaning, and function of values, their presence in the family counselor or therapist as well as in the family in treatment, and the consequences for treatment of the interplay between those two value systems. A brief conceptualization of values is offered, followed by (a) a discussion of family language as a key to identifying salient values, (b) where values are experienced, (c) timing as a value in counseling, (d) the relationship between therapy and the ideology of cultural relativism, (e) midwestern American farming family values thai illustrate an ethnographic approach to family assessment and intervention, and if) therapist values and the professional values of family therapy as a social movement. A number of vignettes from the author's work with families and supervision of family medicine residents in family counseling illustrate the theoretical and methodological issues that are raised.     

The Musings of a Family Therapist in Asia When COVID-19 Struck

In response to the COVID-19 crisis in Asia, a family therapist in Hong Kong shares her experiences and reflections, both personally and professionally from an Eastern lens. From a state of shock and immobilization to moments of contemplation, she highlights her struggle with being caught between her Eastern roots and Western training, which has become more salient in facing COVID-19. While the latter pulls her toward a more problem resolution stance, the former pulls her toward a more accepting position. As a result, her therapy is shaped in such a way that she tends to raise more questions instead of providing answers.     

The Family Therapist Behavior Scale (FTBS): Development and Evaluation of a Coding System

This study evaluated the validity and reliability of a new coding system — The Family Therapist Behavior Scale (FTBS) — that was designed to identify and study clinically relevant verbal behaviors of short-term, problem-oriented family therapists. Validity was assessed by testing the scale's ability to discriminate significant, predicted differences between the in-therapy behaviors of eight beginning family therapists conducting observed interviews and eight advanced family therapists conducting supervisory interviews. All of the sessions, which were initial interviews, were videotaped. Two coders rated three five-minute samples from each of the 16 tapes with the FTBS. The validity results supported over 50 per cent of the 16 research hypotheses. The reliability analysis, based on the actual study data, indicated that the interrater reliability of the 19 category FTBS differed from chance at less than the .001 level of significance. The implications of these findings are examined and future research directions are identified.     

The Soul of Therapy: The Therapist’s Use of Self in the Therapeutic Relationship

This paper is based on the premises that the conscious, active and purposeful use of self by the therapist in the therapeutic process is an essential aptitude in establishing an effective therapeutic relationship, and that this therapeutically purposeful use of self can and should be incorporated in the training of all therapists in a explicitly systematic manner. The paper will attempt to identify the contributions of the “what and how” the use of self by therapists contributes to the therapeutic process. First of all, therapists’ use of self is meant to be viewed as a Common Factor as defined by Sprenkle, Davis & Lebow (2009), which is a perspective about the effectiveness of therapy that “asserts that the qualities and capabilities of the person offering the treatment are more important than the treatment itself” (p. 4). Secondly, the use of self by therapists emphasizes developing the skill set of the therapist in the conscious, active and purposeful use of self as is in the moment of the therapeutic engagement with clients, and does so without denying the importance of therapists working to resolve personal issues of theirs that may interfere with the therapist's professional effectiveness. Therapists’ use of self gives particular emphasis to the purposeful use of self as is in therapy’s relationship, assessment and interventions whatever the therapy model (Aponte & Kissil, 2016). Thirdly, the use of self represents an aptitude that can be developed and refined through well elaborated structures for schooling therapists in the therapeutic use of all they bring of their personal selves to the therapy relationship including through the use of their human vulnerabilities as they exist at the moment of empathic engagement with clients.

     

The Benefits of Interprofessional Collaboration for a Pharmacist and Family Therapist

Abstract

Medical family therapists (MedFTs) and pharmacists in the context of interdisciplinary collaboration will be discussed. In an effort to build and reflect on their own professional experiences, recognizing the need to address wellbeing from a multitude of perspectives, and with the goals of improving access to care by identifying potential partnership opportunities between the two professions, the authors synthesized findings from pertinent articles using Medline and PsycInfo. This paper will illuminate the precise roles of MedFTs and pharmacists, how they fit into the interdisciplinary healthcare team, and anticipated facilitators and barriers in this undertaking to enhance patient care.     

Pathogenesis: A New Therapist Personality Dimension Related to Therapeutic Effectiveness

The pre-project TATs of ten therapists were rated for “pathogenesis” and these ratings later correlated with their patient's level of functioning after six months of treatment. Outcome was measured in a variety of data modalities: intellectual tests, thought disorder measures, projectives, clinical status interviews, and hospitalization. Significant correlations were obtained on five of eight outcome measures. Patients of more benign (or less pathogenic) therapists demonstrated greater foresight, less schizophrenic thought disorder, greater intellectual functioning, were rated as healthier in the Clinical Status Interview, and spent less time in the hospital than patients of more pathogenic therapists.     

The Therapist,the Patient,and the Therapeutic Setting: Mutual Construction of the Setting as a Therapeutic Factor

The author examines several types of therapeutic action intrinsic to Davies's clinical work. Among these actions was Davies's eventual and careful willingness to ask her patient to hold affective states that the patient had previously been unable to hold; to discover a way to speak to her patient about her own struggles with the patient while risking, and actually knowing, that, inevitably, some of the patient's discovery of what the analyst feels will resonate with painful past experience; to create another countertransference space in which Davies found a way to become a different kind of bad or disappointing object to the patient than the patient's earlier disappointment with parental figures, though one that proved much more helpful and bearable than her previous experience; and eventually, though implicitly, to accept the aggressive and harsh ways in which the patient was already experiencing newness in the context of repetitive disappointment. In each of these types of action, the opportunity for mourning figures prominently.     

Heidegger's Brightness as a Responsibility of the Therapist in Existential Family Therapy

The author reflects upon the Heideggerian concepts of thrown-ness, death imagery, arrogance and brightness and their usefulness in existential family therapy. The article describes and illustrates with clinical material the process of helping a couple or family to move from an arrogance response to thrownness and death imagery to the response of brightness as attendants of Being. The responsibilities of the therapist in facilitating such a process are also described.Director of the Worthington Logotherapy Institute, co-director of Lantz and Lantz Counseling Associates, and a professor at The Ohio State University. College of Social Work     

Evaluating Therapist Competency and Adherence to Behavioral Family Management with Bipolar Patients

The present study assessed fidelity to the behavioral family management (BFM) model for treating bipolar disorder patients and their families. The BFM Therapist Competency/Adherence Scale (BFM-TCAS) was developed to evaluate clinicians' competency and adherence to BFM, as outlined by Miklowitz' (1989) BFM Manual for use with bipolar patients. Therapist competency and treatment adherence was also evaluated with regard to two family characteristics: overall level of family difficulty and family expressed emotion (EE) status. The BFM-TCAS was used to code 78 videotaped sessions of 26 families with a bipolar member, selected from a larger treatment study of bipolar disorder patients. The findings suggest that, overall, clinicians adhered closely to the BFM manual. Specific areas in which there was high competency and treatment adherence were (a) skill in conveying factual information about bipolar illness, (b) establishment of a therapeutic environment, and (c) ability to take command of therapy sessions. The one area in which there was less compotency and relatively weak adherence to the manual was the use of between-session homework assignments to assist families in mastering the BFM exercises. Results of this study also suggest that, for the most part, therapist competency and adherence ratings were not related to overall level of difficulty or to family EE status.     

Family Reflections: A Promising Therapeutic Program Designed to Treat Severely Alienated Children and Their Family System

Parental alienation is a form of child psychological abuse and traditional therapeutic approaches do not work with these types of cases. This article provides explanation for the gross failure of traditional therapeutic approaches. The rest of the article discusses the Family Reflections Reunification Program (FRRP), specifically designed to treat severely alienated children and their family system. This program was piloted in 2012 with 22 children in 12 families. Evaluations at the end of the retreat and at 3-month, 6-month, 9-month, and 12-month follow-ups demonstrate a 95% success rate in re-establishing and maintaining a relationship between children and once-rejected parents.     

A Family Therapeutic Approach to Transgenerational Traumatization

The phenomenon of transgenerational traumatization has currently become widely recognized and described, although the task of disentangling the underlying interactional mechanisms remains a difficult one. These transgenerational mechanisms were first detected in families of the survivors of the Holocaust, but they may be equally prominent in families of parents who have been traumatized in other ways, for example, as victims of child neglect and abuse, as orphaned children, or during military service. In cases in which parents have themselves been subjected to early parental deprivation, one or more children may become projectively identified with a parent's (posttraumatic) "bad child"-self, whereas the parent him/herself has identified with — enacts the role of — the idealized internal "martyr" parent. A case study is presented describing the individual and family therapeutic treatment of a woman who, as a child, had been traumatically separated from her parents.     

The Facilitation and Maintenance of the Therapeutic Alliance in Family Therapy

The formation and maintenance of the therapeutic alliance in family therapy involves complexities pertaining to the stabilizing tendency of family systems, and the necessity for negotiation of the goals and tasks of therapy with and among multiple individuals (i.e., the family members) in a context of systemic reciprocity and mutual influence. This article explores the complexities associated with the establishment and maintenance of the therapeutic alliance in family therapy. Alliance stances are presented as clinical applications designed to assist therapists in working with split alliances, establishing within family collaboration, and in negotiating homeostatic processes.     

Privileged Communication in Therapy: Special Problems for the Family and Couples Therapist

Misconceptions concerning the existence and scope of the legal privilege for communications in therapy are considered. Basic limitations on the protection afforded by the privilege are treated, as are some major specific exceptions and waivers, particularly as they raise special difficulties for the therapist who works with groups, couples, and families. Practical suggestions for the therapist and directions for policymaking by the helping professions are presented.