The Integrative Revolution in Couple and Family Therapy

A quiet revolution has resulted in significant movement toward integrative practice in couple and family therapy. This article examines the present status of integrative methods, highlighting the factors that have led to their broad acceptance, issues surrounding the definition of integration and the nomenclature used, the content of recent approaches, and specific conceptual developments and directions.     

Work and Family Conflict: An Often Overlooked Issue in Couple and Family Therapy

Despite the systemic interaction, family-based journals, as well as intake and assessment forms most frequently used by couple and family therapists (CFTs), have given a limited amount of attention to the issue of work and family conflict. Moreover, a review of the literature indicated that many CFTs perceive themselves as inadequately prepared to assist couples and families with work and family conflict. Addressing this apparent limitation, the present study identified various work stressors that contributed to family conflict (WFC), and the family stressors that contributed to work conflict (FWC). Results revealed significant predictors of WFC and FWC. Implications for CFTs and recommendations for changes in academic training and supervision are provided. The authors would like to thank Dr. Gary Bischof, Associate Professor of Counselor Education and Marriage and Family Therapy program Director at Western Michigan University, for editorial comments made on a previous version of this paper.     

Psychoanalytic Models of the Mind for Couple and Family Therapy

This paper describes an object relations theory of mind that highlights the interactive origin of psychic function and the beginnings of mental structure in the infant's relationships within the family group. Based on this model, psychoanalytic family and couple therapy employs the interactions between family and therapist to detect and work with developmental failures in holding and containment, skewed family projective identification, and attacks on linking, which characterize pathological and traumatized families. The coming together of transference generated by the family as a group and the therapist's countertransference are the fulcrum on which such therapy turns. An extended vignette of a session is used to illustrate the application of object relations theory to the therapeutic process of family therapy.     

Case Conceptualization: A Strategy for Incorporating Individual,Couple and Family Dynamics in the Treatment Process

While market and regulatory forces have made case conceptualizations essential in individual, couple and family therapy, therapists, trainees, and supervisors are increasingly recognizing the clinical value and utility of case conceptualizations in everyday practice. This article describes and critically analyzes three main types of case conceptualization and argues that the client-focused type is the most appropriate in addressing theoretical and clinical considerations. A client-focused type with a phenomenological and systematic emphasis, called pattern analysis, is described. A detailed case study illustrates pattern analysis.     

Couple and Family Therapy Within the Current Pan-Canadian Context

Canadians take numerous approaches to couple and family therapy due in part to Canada’s diversity of people and geography, as well as the influence of the health care context, a central facet of our national identity. Tracing back to Nathan Epstein, the founder of family therapy in Canada, there continues to be a strong tradition of couple and family therapy within Canada which has international reach. Formal training in family therapy, as well as couple/marital therapy occurs largely outside of the scope of degree granting programs and university settings. The American Association for Marriage and Family Therapy has a strong presence in Canada, with six divisions across the country. Popular models of practice for Canada’s couple and family therapists include cognitive-behavioral therapy, solution-focused therapy, narrative therapy, emotionally-focused therapy, and Bowenian/intergenerational therapy. A growing number of training opportunities are becoming available across Canada, and the practice of couple and family therapy is becoming institutionalized as one of the core competencies for professions such as psychiatry. In this article, we examine the context of family therapy in Canada by examining its history, the unique accreditation standards, qualifications and organizations associated with family therapy, the relationship between couple and family therapy, and future directions for this field of practice.     

Family Therapy Training: Program and Outcome

A family therapy training program has been conducted for staff of mental health agencies located throughout Pennsylvania. This paper is a report on the content and results of the four-year-old training program. Three hundred practitioners have been trained in family therapy. The program has also led to the development of a core group of 64 family therapy trainers. There has been an associated delivery of more family-oriented mental health services throughout the Commonwealth.     

Video Game Therapy: Application of the Couple and Family Technology Framework

The couple and family technology framework outlines how technology affects couple and family relationships. This framework has been applied to understanding the impact of technology on infidelity, contributed to our understanding of online gaming issues in couple relationships, and sexting. The purpose of this paper is to outline how to implement video gaming as a disciplinary tool for youth congruent with the couple and family technology framework. Specifically, we identify the elements of video games that can be applied as an intervention in family treatment with youth in a token economy. This proposed technique focuses on utilizing technology (and specifically video games) as a strategy to improve youth’s behavior. Consistent with the couple and family technology framework, this paper outlines how accessibility, affordability, accommodation, and approximation can be used to improve behavior as well as improve parent–child relationships. Implications are included.     

Family Therapy Training: Academic and Internship Opportunities for Psychologists

Institutions that train psychologists in psychotherapy skills have generally neglected the family approach. This article provides information on both university departments of psychology and psychology internship facilities that include family therapy training in their programs.     

Family Therapy Training: The Institutional Base

The papers that follow present the findings of three surveys of the institutional base for training in family therapy. ¹ 1 Names and addresses of all facilities known to provide education in this field as of 1980 are available at a charge of U.S. $10.00; checks are to be made out to Family Process.
The surveys were initiated and conducted independently. To some extent they overlap. This is particularly true of the Bloch and Weiss effort in that it does not limit itself to a sector of the training process bounded by a single discipline, as do the other two papers. Despite some overlap, each paper stands independently; of particular interest are the varied analyses and special emphases each provides. We hope that their publication will stimulate similar studies in the years to come, so that family therapy can take advantage of the observation of its own growth and development. We are accustomed to including ourselves in the field of observation, so far as the family system is concerned; it seems reasonable to extend these perspectives to the more macroscopic field of the institutional development of family therapy. Of particular importance to us, and I believe to science generally, is the opportunity to observe a paradigmatic shift taking place with the development of this new field and the adoption of its associated epistemology by the senior professions of social work, psychology, and psychiatry. Family systems theory and practice have implications that extend beyond their own borders; they can make a significant contribution to the systems revolution that is taking place in science generally. These studies should be of use to practitioners, teachers, and students alike. It seems to me that their implications are clear: that training in family therapy at a sophisticated level is now to be a regular part of the future training of psychiatrists (possibly all physicians), psychologists, social workers, and psychiatric nurses and that, in addition, as a second distinctive career line, there is the new profession of family therapist, with its own entry point and academic pathway. My view is that society will support both lines of career development as far into the future as one can reasonably hope to see. The only logical ending to this will be a shift in the medical model from its present linear definitions of illness and treatment to an ecosystemic, biopsychosocial definition. These describe a historical crosssection through that process.     

Training Facilities in Marital and Family Therapy

This survey reports the results of a national survey of training programs in family therapy. Two hundred and forty-five programs responded to the survey questionnaire providing data for the development of a master list of training programs and a general assessment of the nature and magnitude of training efforts in the field. The survey included programs housed in diverse institutional settings. The data indicate the extent of growth and the increasing formalization of professional training in family therapy. A classification system is proposed for distinguishing among the major types of facilities providing family therapy training. Programs are compared in terms of the type, duration, and intensity of the training offered and the number of students enrolled.     

Family Therapy Training and Workforce Planning

There is a strong argument for further developing family therapy as a profession within the NHS, using the mechanisms for workforce planning at regional and national levels. Family therapy can be a full-time occupation, as a profession and a secondary activity, as systemic practice. There is ambivalence about professionalism within the field and at different levels of society. This article outlines areas of tension between family therapy and government policies which focus on evidence-based practice. Full integration into the NHS is possible through the career structure which links family therapy with clinical psychology, adult and child psychotherapy, and provides a model for linking workforce planning with education. There are risks of family therapy becoming marginalized in the future, as a profession or as systemic practice, unless it connects better with workforce planning.     

Family and Systems Therapy and Training in Portugal

The history of systemic family therapy in Portugal since its appearance until the present is discussed. Some data on systemic family therapists’ training is provided in the context of the Portuguese Society of Family Therapy and Academic Institutions. In Portugal, family therapy has been extended to various contexts, including medical and community services. Finally, future directions for family and systems therapy practice and training in Portugal are provided emphasizing the importance of family interventions as an important resource to empower families living with health chronic conditions. The Portuguese Family Therapy Society, every 2 years, organizes a scientific Iberian conference with Portuguese and Spanish speakers. This allows the exchange of clinical experience and research about family and systems theory.     

Team Family Therapy Training: Conceptual and Pragmatic Considerations

This paper presents a family therapy training model that can be used to teach conceptual and executive skills to beginning therapists in community and academic settings. The model is based on the organization and philosophy of family therapy teams and the methods of live supervision. The goals, structure, and leadership of traditional family therapy teams are discussed and contrasted with the proposed team training model. Pragmatic details of the training program are described and advantages and disadvantages explored. Team leadership skills are categorized by context and future directions proposed.     

Differences in Dropout Rates Among Individual, Couple, and Family Therapy Clients

The premature dropout of clients from therapy is an inefficient expenditure of mental health resources. This study examined differences in dropout rates among individual, couple, and family therapy clients. Data came from archived records at a marriage and family therapy clinic at a university in the United States. Results indicated that there were no significant differences in dropout rates, despite the use of multiple measures of dropout. Thus, from a mental health services perspective, administrators and clinicians can expect that dropout rates will remain fairly consistent across treatment modalities.     

Family Therapy Training in Clinical Psychology Programs

In a national questionnaire survey of graduate programs offering the Ph.D. or Psy.D. in clinical psychology, the status of family therapy training was examined. With a 79 per cent response rate (102 programs), the study found that 10 per cent of the nationwide faculty identified themselves as primarily family therapy oriented, 32 per cent of the programs had no family-oriented faculty members, 18 per cent of all psychotherapy courses were family therapy courses, and 21 per cent of the schools had no family therapy course. The ratings of the importance of providing students with family therapy training were found to be unrelated to the number of family therapy courses available but positively correlated with the percentage of family therapy courses within the total curriculum.