A taste of reflecting practice

This article describes a training exercise in which students who are new to systemic practice but have some experience in therapeutic work in other modalities were invited to experience reflecting practice. The students were asked to follow a role‐played therapy session by offering reflections on the connections felt to a ‘family’ member. The students stood beside the ‘family member’, reflected on the problems and accounted for the connections felt in terms of particular resonances felt. The students thus experienced a therapeutic use of self congruent with the reflecting team approach and the therapeutic position adopted in reflecting practice.     

Depressed youth: treatment outcome and changes in family functioning in individual and family therapy

This study explores the role of family functioning in therapeutic change in focused individual psychodynamic psychotherapy (FIPP) and time‐limited systems integrative family therapy (SIFT) for depressed children and adolescents. After a screening process, 72 participants aged 8 to 15 were randomized to either FIPP or time‐limited SIFT. Assessments took place prior to, at the end of, and 6 months after treatment. Families in both SIFT and FIPP showed a small but significant and sustained improvement in family functioning by the end of treatment in both mothers' self‐reports and family therapists' assessments. Better family functioning at baseline in mothers' self‐reports and improved family functioning during SIFT, as assessed by family therapists, predicted a sustained decrease in self‐reported depressive symptoms. Results indicated that time‐limited SIFT may be more effective with younger children and in patients without a diagnosis of double depression than adolescents.     

Beneficial factors in family discussion groups of a psychiatric day clinic: perceptions by the therapeutic team and the families of the therapeutic process

This paper reports a pilot investigation of the perception of helpful events by the therapeutic team and the families in two family discussion groups (FDGs) of a psychiatric day clinic. All participants of the FDG, including therapists and observers, filled in questionnaires measuring events helpful for the individual, for the family and for the group after each FDG session. The results showed that the therapeutic team and the families diverged in their overall perception of which factors were important in family discussion group therapy. The therapeutic team saw the relational climate and the structural aspects of the group (including group involvement and support from the group), and specific therapeutic interventions as more helpful than the families. The process aspects in the group members (including the experiencing of communality and gaining insight) were, on the other hand, more frequently mentioned by the families than by the therapeutic team. The clinical implications of these findings and suggestions for future research are discussed.     

The Added Value of Studying Embodied Responses in Couple Therapy Research: A Case Study

This article reports on the added value of embodied responses identified through sympathetic nervous system (SNS) activity in couple therapy research. It focuses on moments of change and the timing of therapeutic interventions or therapeutic moves in a couple therapy session. The data for this single‐case study comprise couple therapy process videotapes recorded in a multi‐camera setting, and measurements of participants’ SNS activity. The voluntary participants were a marital couple in their late thirties and two middle‐aged male psychotherapists. The division into topic segments showed how the key issue of seeking help, which was found to comprise three separate components, was repeatedly dealt with in the session. SNS activity showed different degrees of synchronization between the couple, between the therapists, and between the couple and therapists during the dialogue pertaining to these three components. The issue of timing emerged as a complex, even ambivalent, phenomenon. Arousal in the therapists was in line with their therapeutic activity, whereas in the clients it was more anticipatory. The approach used here rendered visible some of the intensity that therapeutic dialogue can generate when dealing with issues of relationship change in the couple context and showed how this intensity can be dialogically regulated in the therapeutic system.     

Primary Process Communication

An unorthodox view of the function of primary process is presented with a view to enlarge, rather than diminish Freudian assumptions. One of the basic tenets of Freudian hypothesis was the supposed lack of influence of outside experience upon primary process functions. Yet we see demonstrated on a daily basis that primary process cognition is at work in any human interaction or experience. The mental structures of the self in interaction with the nonself is constantly monitored, added to, or subtracted from during contact with others. It is a prereflective mode that does not immediately rise into awareness. We give meaning to all interactions without necessarily reflecting upon them or even clarifying them to ourselves. Without allowing for such meaning to be integrated, we would lose or misinterpret large portions of our daily interactions. Flaws in communication occur every day and are demonstrable particularly in therapy when therapists are not attuned to their patients' emotional needs. It is demonstrated that nonverbal avoidance behavior of disturbed infants is the precursor for disturbed object relations of adults. Therefore, it makes no sense to interpret unconscious meanings—there are none. The difficulty lies in the inter-subjective realm and serves defensive modes. However, if patients present an inauthentic self, it is often difficult to decide if one is indeed in the presence of such a maimed self. The therapist's countertransference aids in detecting inaulhenticity. Ever-present, unconscious meaning analysis must be brought into consciousness by the therapist in order to further the therapeutic process.     

Contingencies promote delay tolerance

The effectiveness of functional communication training as treatment for problem behavior depends on the extent to which treatment can be extended to typical environments that include unavoidable and unpredictable reinforcement delays. Time‐based progressive delay (TBPD) often results in the loss of acquired communication responses and the resurgence of problem behavior, whereas contingency‐based progressive delay (CBPD) appears to be effective for increasing tolerance for delayed reinforcement. No direct comparison of TBPD and CBPD has, however, been conducted. We used single‐subject designs to compare the relative efficacy of TBPD and CBPD. Four individuals who engaged in problem behavior (e.g., aggression, vocal and motor disruptions, self‐injury) participated. Results were consistent across all participants, and showed lower rates of problem behavior and collateral responses during CBPD than during TBPD. The generality of CBPD treatment effects, including optimal rates of communication and compliance with demands, was demonstrated across a small but heterogeneous group of participants, reinforcement contingencies, and contexts.     

Accountability Reduces Unconscious Plagiarism

We investigated how holding participants accountable for their responses affected unconscious plagiarism when solving a Boggle puzzle task (finding words in a 4 × 4 letter matrix). Both experimental and control participants (N = 60) generated puzzle solutions with a computer partner, recalled their own previously generated solutions, and then produced new solutions to the puzzles. Accountability was manipulated by telling participants in the experimental group before beginning the initial‐generation phase that at the end of the session, they would review their generated responses with the researcher (accountable participants). Accountable participants plagiarized less than control participants when generating words with the computer and generating new solutions on their own but not when they were attempting to recall words they initially generated. The data are discussed in terms of the leading theoretical explanation of unconscious plagiarism, the source‐monitoring framework. Copyright © 2012 John Wiley & Sons, Ltd.     

Social justice competencies for counselling and psychotherapy: Perceptions of experienced practitioners and implications for contemporary practice

The purpose of the present study was to identify social justice competencies from the perspective of psychotherapists engaged in therapeutic practice. Twenty‐five therapists were asked, “What social justice competencies do psychotherapists need?” Responses were analysed using the concept mapping method. Nine participants grouped all unique interview responses into groups. Multidimensional scaling and cluster analysis were applied. The six competency areas identified included community activism, political influence on clinical work, critical consciousness, social responsibility, self‐awareness and personal style. The results were compared and contrasted with the literature. Considerable overlap was noted. The main differences concerned the need for collaboration as an advocacy tactic, as well as local knowledge about the pressing social issues affecting members of the community within which one practices.     

Self‐directed work groups and team competence

The study examines the impact of self‐directed group work on team competence. The sample consists of 83 production groups from 20 medium‐sized enterprises: 44 self‐directed work groups and 39 traditional work groups. Results based on process‐analytic behavioural data, collected at the group level of analysis, show that self‐directed teams are more competent than traditional work groups on seven out of 12 aspects of competence. Self‐directed teams show greater methodological competence, to some extent greater professional and self‐competence but no greater social competence when completing optimization tasks. In addition, the work characteristics participation, formal team communication, continuous improvement process, training and team‐oriented tasks were related to team competence in the subsample of self‐directed work teams.     

The incidence of Freudian self‐analysis in the construction of the psychoanalytic theory of anxiety

The value and function of self‐analysis has been a contentious issue in several studies dedicated to the Freudian legacy. For some writers, Freud's experience of self‐analysis is rightly considered to be the master key to an understanding of the origins of the fundamentals of psychoanalysis. For others, the exaggerated importance attributed to the process merely led to the construction of a foundational myth. Nevertheless, if it is recognized to be a process in which Freud, in collaboration with Fliess, analysed personal aspects, working hypotheses and psychopathological debates, a reconsideration of self‐analysis may contribute new elements to our understanding of the paths that were taken in the elaboration of the theory and practice of pyschoanalysis. Starting from this premise, the present work will consider the systematic examination that Freud conducted of his own phobia in the course of his self‐analysis to be a process of great relevance to the elaboration of the early psychoanlytic conceptualizations of anxiety, in that in the course of this process the possible role of sexuality, fantasy, memory and unconscious determinism in the etiology of anxiety became part of the discussion.     

Ritual and spontaneity in healthcare and in the organisation of therapeutic communities

The author, following constructivist psychoanalysis, observes a dialectic at work in the therapeutic community between knowledge and authority of the analyst and his/her spontaneity on the one hand, and between the formal and informal roles that therapists adopt in a therapeutic community on the other hand. The key to successful therapy, he suggests, lies in maintaining this dialectic. He then goes on to discuss the function of staff teams in therapeutic communities and the importance of taking into account the patients’ unconscious representations of the team. He stresses the need for leadership in therapeutic communities and in engaging with moral issues and not just clinical ones.     

The Debate: A Strategic Technique

This paper describes the work of a strategic team that came out from behind the one-way mirror. A debate among the team is enacted before the family as a strategy for change. The case of a family that refused to provide information illustrates an application of this method. The debate among the therapists represents a dilemma that is a strategically constructed isomorph of the family situation. From this position, therapists have the option of changing levels between themselves and the family, asking the family to help solve the therapists' dilemma so that they in turn can be free to help the family. The combination of the debate and the change of levels between the therapists and the family creates a therapeutic neutrality for the family. From their meta position, they observe the therapists' struggle to solve the family's problem, which is re-presented as a problem among the therapists. This perspective offers the family the choice of more adaptive solutions to their own dilemma.     

Do primary care psychological therapists ‘think family’? Challenges and opportunities for couple and family therapy in the context of ‘Improving Access to Psychological Therapies’ (IAPT) services

Very little couple or family work takes place in primary care despite the advantages offered by the context. This pilot study investigated the experiences of primary care adult therapists regarding the place of families in their clinical work. Semi‐structured interviews with seven therapists were analysed using interpretative phenomenological analysis. The findings tentatively suggest that primary care psychological therapists ‘think family’ primarily from the perspective of their main therapeutic model when offering individual therapy. Some study participants questioned the appropriateness of their family/context focus. Family members were extremely rarely seen together. Facilitating factors included supervision and training. Barriers to family work were both external (the work setting) and internal (beliefs about it). The impact of the current dominance of cognitive behavioural therapy in National Health Service adult psychological therapy services and the development of Improving Access to Psychological Therapies (IAPT) services on the provision of couple and family therapy are discussed. Some challenges and opportunities presented by IAPT for couple and family therapy are explored.     

Virginia Satir’s Family Camp Experiment: An Intentional Growth Community Still in Process

In 1976, Virginia Satir began Satir Family Camp (SFC) with therapists and their personal families. Initially, it was a context for the family to experience Satir’s concepts and techniques so that the family system would change along with the therapist. The training of therapists is no longer a significant part of camp; relationships with self, family, friends, and the community is now the main focal point. The process and governance of the camp is presented along with a lengthy anecdote of an experiential family session. These two features—community function and personal/familial growth—inextricably work together to provide a validating environment that supports desired changes.     

Implementing Family-Based Musical Interventions in Family Therapy: A Mixed-Methods Research

Although rarely used by family therapists, musical interventions have the potential to become a more common technique in family therapy. Music’s unique therapeutic properties engage families, including young children and adolescents, in a meaningful, therapeutic, “here-and-now” creative process. Musical interventions act as catalysts, enable direct communication, and augment authentic communication patterns in a playful atmosphere. The purpose of this explanatory mixed-methods research was to obtain a greater understanding of the clinical applicability, therapeutic value and future implementation of a musical intervention carried out by family therapists in a family therapy context. The study explored the outcomes of 35 participating family therapists who attended a designated workshop on a structured family-based musical intervention, 18 of whom then applied 38 family-based musical sessions focused on family roles in their clinical work. The results illustrate the family-based musical intervention is a noteworthy tool for family clinical assessment and treatment, easily applicable in a variety of private and public settings with diverse populations. Musical instruments used as intermediary objects are potent vehicles for growing family awareness, functioning, and congruence, as well as inducing opportunities for change. The family-based musical intervention manifests the potential of an interdisciplinary, holistic, biopsychosocial approach to promoting individual and family wellbeing. The article also addresses ethical considerations and implications for family therapy training and education programs.     

Empowering Change Agents: Youth Organizing Groups as Sites for Sociopolitical Development

In addition to social action campaigns, some youth organizing groups provide formative learning experiences which engage youth in relevant sociopolitical issues through critical approaches. These groups support sociopolitical development (SPD), a self and socially‐oriented process which influences youth personally, politically, and professionally into adulthood. This study explored how youth organizing experiences influenced SPD in the professional domain, applying an empowerment lens. Phenomenologically‐based interviews were conducted with former sexual health education youth organizers and adult program staff. Former youth participants chose socially‐oriented career paths influenced by the group's empowering approach to sexual health education and advocacy. They related meaningful sociopolitical learning experiences (e.g., interpersonal, educational, and civic engagement) to empowerment outcomes (e.g., political efficacy, critical awareness, and participatory behaviors) which informed career decisions. Professionally, participants sought to empower others as the group empowered them, drawing upon youth organizing social and human capital as they worked toward this aim. Combining sociopolitical and empowerment theorizing, the study adds to what is known about how purposefully designed youth organizing experiences support long‐term development outcomes for individuals. Viewed as socially‐oriented career development sites, youth organizing groups build capacity for social change beyond the groups themselves. Implications for youth organizing scholars and practitioners are provided.     

Change: How do we recognize it?

The paper seeks to examine the working assumptions that guide us as therapists engaged in the attempt to facilitate change in families. It summarizes a piece of preliminary research based on the responses of a group of therapists working in different agencies. A questionnaire on change was developed and given to the therapists followed by a group discussion.
The results suggest that therapy teams, and families, have common sense ideas about:

• the beginning, and end of a period of change;

• types of change—those falling into four categories; of behavioural, structural, communication and experiential.

Our results suggest that difficulties in therapy may be associated with a failure amongst the therapists in a team to negotiate their mutual assumptions about change. In addition the process of therapeutic change is seen as involving a negotiation between the family and the therapists about what will count as change.
The data were gathered from a group of therapists attending a local meeting of the Association for Family Therapy in Plymouth.     

‘Coming out’ in therapy? Perceived risks and benefits of self‐disclosure of sexual orientation by gay and lesbian therapists to straight clients

Primary objective: The study's primary objective was to investigate the experiences of gay and lesbian therapists, when considering self‐disclosure of their sexual orientation to straight (i.e. heterosexual) clients. This qualitative study set out to ascertain the key factors gay therapists take into account when considering this decision and to explore the effects this self‐disclosure may have on themselves, their clients and their therapeutic relationships. Research design: The research design was based on the use of semi‐structured interviews, undertaken with a non‐random, purposive sample of counsellors and psychotherapists (n=8) in current practice. The rationale for this method was to aid exploration of therapists' experiences of the process of self‐disclosure. Methods and procedures: Inclusion criteria were for therapists who self‐identified as being gay or lesbian, and who were experienced in clinical work with straight clients. Transcribed data was analysed using inductive thematic analysis. Main outcomes and results: Some therapists reported being confident with self‐disclosure relating to their own sexual orientation. However, a common theme related to the reportedly high levels of anxiety and vulnerability, which therapists identified. Key themes emerged around: respondents' fears of client judgement; a need for therapist self‐protection; self‐awareness of the potential impact of their own fears and prejudices on the therapeutic relationship; and the potential relevance of internalised homophobia, as an overall constraining factor. Conclusions: Self‐disclosure of their sexual orientation to straight clients is constructed, in this initial survey, as being potentially problematic and risky for some gay therapists.