Intensive specialised multi-family therapy for multi-stressed families: Therapeutic alliance as predictor for effectiveness

The effectiveness of intense specialised multi-family therapy (ISMFT) for 111 multi-stressed families, and the therapeutic alliance as a possible predictor of outcome, were examined. A repeated measures design was used, where changes in all ISMFT phases (preparation, multi-family therapy and follow-up) were assessed and compared for both mothers and fathers. Evidence was found for improved family functioning after the therapy period, which was maintained at 3 months follow-up, although the multi-stressed families still functioned in the problematic range. The therapy did however not decrease parenting stress, or did so only temporarily. Observations of the therapeutic alliance with the System for Observing Family Therapy Alliances (SOFTA) scales indicated that high therapist engagement was related to positive therapy outcomes, both at the start of therapy and later. High family engagement also predicted therapy effectiveness, but only at the start of therapy. The present study shows that solution-focused multi-family therapy at least seems to provide the first step in alleviating problems in multi-stressed families.     

In-home treatment for families in crisis and its supervision: A systemic multi-level approach

The author discusses his experience with a five-phase model which built on congruency at all systemic levels of in-home family treatment and its supervision. Five phases are presented, as well as the group process during supervision. In-home family treatment confronts the family helper with different tasks in each phase of the treatment process and with different expectations within the professional network and the institutional context.The author's work as a supervisor and trainer of in-home family treatment was made possible by Diakonisches Werk Hannover. Grateful acknowledgment is made to Heike Müller, Claudia Eckert, and all their colleagues for their trust and support, to Winiger Beuse for his professional friendship, and most importantly to Dr. Carole Gammer and Prof. Dr. Martin Kirschenbaum for their helpful comments on an earlier version of this paper. Thank you Sandy and Susan. In this article the German expression Sozialpädagogischer/r Familienhelfer/in is translated into family helper. In Hannover, as in many other German cities, family helpers are graduate social workers. Family therapy training is not obligatory but appreciated.     

Clinician experiences of homework in couples and family therapy: A survey of perceived impact on the working alliance

The process of engaging clients in homework assignments has been studied extensively in research settings, but rarely have the challenges in the implementation of the science been considered in couples and family therapy. A survey was conducted of 226 clinicians regarding (1) their experience of homework adherence (quantity and quality) with couple and family clients, and (2) their experience of the impact of homework non-completion (IHN) on the working alliance. Clinicians working with families reported less overall homework quantity and quality. However, across both couples and family clients, more negative IHN was reported among clinicians experiencing less homework quantity, both in terms of IHN bond (couple ρ = 0.71, p < 0.001; family ρ = 0.78, p < 0.001) and IHN agreement (couples ρ = 0.25, p < 0.001; ρ = 0.19, p = 0.006), and among clinicians with fewer years of clinical experience (r = 0.19, n = 136, p < 0.05). The present findings suggest that, in the context of couples and family therapy, there is a risk of perceived negative IHN on the working alliance. There would be merit to future investigations examining the processes of facilitating homework engagement within the context of a strong working alliance.     

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.     

Cultural ruptures in short‐term therapy: Working alliance as a mediator between clients' perceptions of microaggressions and therapy outcomes

Aim: To determine whether or not clients' perceptions of microaggressions varied based on their own and the therapist's race/ethnicity and whether or not they would be negatively related to the effectiveness of therapy and if the working alliance would mediate this effect. Method: The study utilised a cross‐sectional, retrospective, methodology. Clients were recruited from a large university counselling centre in the United States (N=232 clients and 29 therapists). Results: Neither clients' race/ethnicity, therapists’ race/ethnicity, nor client‐therapist ethnic matching predicted perceptions of microaggressions. Clients' ratings of microaggressions were negatively associated with their psychological wellbeing; however, this effect was mediated by clients' ratings of the working alliance. Implications: Therapists should take into account the cultural messages they may be conveying to both white and racial/ethnic minority clients. Therapists should develop strategies that are consistent with a general therapeutic approach that promotes discussions about culture with their clients and, most importantly, should attend to the therapeutic relationship.     

Me and My Shadow: Therapy with Sexually Abused Pre-Adolescents

The purpose of this paper is to describe the use of solution focused techniques with preadolescent children who have been sexually abused and to present a therapeutic model that: 1) represents a blending of traditional psychological theoretical ideas with the more recent solution focused techniques; 2) presents a unique time-limited group format for assisting children to come to know and like their authentic selves; and 3) provides the therapist with the opportunity to expand his or her roles. In this model, the path from false self to authentic self is conceptualized as an interplay among abuse events, family relationships, and other life contexts.     

Use of nature in a multi-family therapy for Chinese families of adolescents with attention deficit hyperactivity disorder: A photo-elicitation study

This article reports the therapeutic resources in the natural outdoors that were conducive to the therapeutic process in a multi-family therapy (MFT) for enhancing the self-efficacy and collective family efficacy of Chinese families of adolescents with attention deficit hyperactivity disorder (ADHD) in Hong Kong. Photo-elicited interviews with adolescents with ADHD and parent focus groups were employed to explore the participatory experiences of the families. A total of thirteen Chinese families of adolescents (aged 11–15 years) with ADHD participated in this study (fourteen adolescents with ADHD, eight fathers and ten mothers). The present study explored the potential therapeutic resources in the natural outdoors, namely a change in the group environment, spaciousness and darkness. The use of the natural outdoors in MFT proved to be a strategy useful for creating a naturalistic group setting within which family participants can more easily enact changes.     

Client crying in the context of family therapy: an exploratory study

This study explores the crying episodes of twenty‐eight clients treated at a family therapy service in a community centre. The crying episodes were associated with some significant elements: the time of appearance, the content and triggering factor, the interpersonal context of sessions and the emotions clients had for the therapist, as well as the therapy's outcome (end of treatment and the satisfaction of clients). Crying was much more frequent during the first session. It occurred more frequently when there was another family member present. The proportion of clients who cried during the treatment was significantly higher for clients who completed it successfully. Clients who cried perceived the therapist, in all cases, as a kind person who never got annoyed with them. Crying could be considered a type of behaviour that helps the therapist to create a safe context and foster the therapeutic alliance.     

Addressing power in couples therapy: Integrating socio-emotional relationship therapy and emotionally focused therapy

Romantic relationships are more satisfying and fulfilling when power is balanced relatively equally between partners (Leonhardt et al., Journal of Family Psychology, 34, 2020, and 1). Yet, few couples therapy models explicitly outline how to confront relational power issues (Knudson-Martin & Huenergardt, 2015, Socio-emotional relationship therapy: Bridging emotion, societal context, and couple interaction, Springer). Emotionally Focused Therapy (EFT; Johnson, 2020, The practice of emotionally focused couple therapy, Routledge) is a well-established, evidence-based therapy modality that many therapists use with couple clients, yet despite its effectiveness, it does not provide direction for explicitly addressing and treating power differentials in couple relationships. In this paper, we explore the integration of EFT with Socio-emotional Relationship Therapy (SERT), a model overlay that acknowledges the impact of social discourse on enactments of power in intimate couple relationships. We first address the importance of understanding power in couple relationships, addressing power in couples therapy, and provide a brief overview of SERT and EFT. We then introduce an integration of the models intended to help therapists balance power, increase connection, and secure attachment bonds between romantic partners.     

Selective mutism in children: A structural family therapy approach to treatment

When children refuse to speak in some social settings, but can understand and speak in other settings, the diagnosis of selective mutism must be considered. A review of the literature describes the disorder, the various types of mutism, and related family dynamics. A family systems approach to treatment using structural family therapy is suggested. The case history presented illustrates one type of mutism as well as the family rules and hierarchy which appeared to be maintaining it. Structural and strategic family systems theory techniques that were used to move the family toward resolution of this problem are discussed.Diane Wolf Tatem, MA, MS, completed graduate work in marriage and family therapy at New Mexico State University, Las Cruces, NM. She is employed at Life Management Center of El Paso's Child Development Services and also has a private practice in marriage and family therapy in El Paso, Texas. Robert L. DelCampo, PhD is a professor of family science at New Mexico State University and maintains a private practice with Associates for Marriage and Family Therapy in Las Cruces, NM. Please address all correspondence to Dr. DelCampo at Box 3470, New Mexico State University, Las Cruces, NM, 88003-3470.Appreciation is expressed to Dr. Charles Huber, New Mexico State University in Las Cruces, for his insightful critique of the final draft of this paper. This paper was presented at the Texas Association for Marriage and Family Therapy Annual Conference, January 25–29, 1995 in Dallas, TX.     

Turning differences into possibilities: Using discourse analysis to investigate change in therapy with adolescents and their families

Discourse analysis affords researchers and practitioners improved understandings regarding how positive outcomes are accomplished in the conversations of family therapy. By investigating how change is constructed or ‘performed’ in therapeutic interactions, its analyses conceptually parallel those of the social constructionist approaches to family therapy. In this respect, discourse analysis offers empirical methods to examine claims about the constructive aspects of therapeutic conversations. These conceptual and research parallels are examined in how impasses in family therapy were transcended, rhetorically, between an adolescent, his parents and the therapist. We conclude that the research methods of discourse analysis can directly enhance the conversational skills and methods of therapists.     

Therapeutic alliance and progress in couple therapy: multiple perspectives

Therapeutic alliance research in couple therapy using multiple perspectives and longitudinal data has been sparse. This study used structural equation modelling to explore relationships between changes in alliance and in progress from clients' and therapists' perspective in a fairly large sample of couples (N=195) during the initial stage of therapy at an on‐campus training clinic. Self‐rated alliance was measured after sessions 2 through 4 with the Working Alliance Inventory. There was very little change in alliance over the early sessions of therapy, and changes in alliance did not always account for changes in relationship satisfaction. Husbands' perceptions of satisfaction and alliance seem to play an important role in the dynamics of the therapeutic process. Findings suggest a reciprocal relationship between perceptions of alliance and progress in therapy when combining perceptions of therapists and couple clients. Clinical implications and future research are discussed.     

The elephant tied up with string: a clinical case study showing the importance of NHS provision of intensive,time-limited psychoanalytic psychotherapy treatments

Prof. Richard Layard's influential advocacy for greater provision of ‘evidence-based’ psychological therapies, based in part on an economic rationale, has lead to greatly increased provision of cognitive behavioural therapy (CBT) and short-term therapies for depression, through the Increasing Access to Psychological Therapies (IAPT) initiative, whilst longer-term psychodynamic treatments are under threat, criticised as lacking an evidence base. This paper argues for the continuing provision of intensive thrice-weekly psychoanalytic psychotherapy treatments, time-limited to two years. It does so by describing such a treatment within an NHS psychotherapy department with a patient with a long history of severe personality pathology, including significant levels of perversity. The paper describes the patient's difficulties and his movement through the treatment, focussing on his difficulties making genuine emotional contact, his destructiveness of such contact, his acting out in the treatment, his perversity and the vital working through of the ending. The shifts the patient made are described, and follow-up information on the patient is given. The paper discusses the unique benefits of time-limited treatment and intensive psychoanalytic treatments for this ‘hard-to-help’ group of patients, and the economic rationale that can be made for such treatments.     

Forced migration and resettlement: Its impact on families and individuals

An increasing number of families are forced to migrate as a result of political turmoil, civil wars, and ethnic cleansing. This paper describes the impact of forced migration on individuals and their families. We suggest that forced migrants reject the new culture while their children are likely to embrace it. This discrepancy between the old values of the migrants and the values to the new culture espoused by their children is a frequent source of intrafamilial tension. We also describe a second acculturation process that takes place when forced migrants return to their country of origin. Families who migrate back to the country of origin realize, often to their surprise, that both they and their country of origin have changed significantly.     

Family Therapy with English Caribbean Immigrant Families in the United States: Issues of Emigration, Immigration, Culture, and Race

Many English Caribbean families in the United States are referred for therapy because of difficulties related to their adaptation to a new country/culture. This paper focuses on the intra-familial, and the family-larger system transitional/adjustment difficulties experienced by these families and presents issues specific to therapy with them. Effective therapy with English Caribbean families and their subsystems requires that therapists communicate to these families an understanding of their concerns, be knowledgeable about heterogeneity in cultural values and traditions, and create a therapeutic atmosphere in which families can feel valued and respected. Recommendations for therapists are presented and discussed.     

participating in a couples therapy outcome study: Participants' views

Discovering that participants who received therapy in a research project and were being debriefed in a therapy outcome study considered those assessment sessions therapeutic, the authors conclude that participants: (a) are aware of the research context, (b) have some idea about how it affected the treatment they got, and (c) see positive outcomes for taking part in the study. Assessment and treatment were not separated in the minds of some participants, as they had been in the mind of the researchers.This study was supported in part by National Institute on Drug Abuse grant #1R 18DA 1069232001.     

Attachment-based family therapy for depressed adolescents: programmatic treatment development

Few effective psychosocial treatment models for depressed adolescents have been developed, let alone ones that use the developmentally potent context of the family as the focus of intervention. Attachment-based family therapy (ABFT) is a brief, manualized treatment model tailored to the specific needs of depressed adolescents and their families. Attachment theory serves as the main theoretical framework to guide the process of repairing relational ruptures and rebuilding trustworthy relationships. Empirically supported risk factors for depression are the primary problem states that therapists target with specific treatment strategies or tasks. Parent problem states include criticism/hostility, personal distress, parenting skills, and disengagement. Adolescent problem states include motivation, negative self-concept, poor affect regulation, and disengagement. Intervention tasks include relational reframing, building alliances with the adolescent and with the parent, addressing attachment failures, and building competency. A small, randomized clinical trial provides initial support for the model. Several process research studies, using both qualitative and quantitative methods, have helped refine the clinical guidelines for each treatment task. ABFT is a promising new treatment for depressed adolescents and more research on it is warranted.     

Making Sense of Abuse: Case Studies in Sibling Incest

This case study focused on the process of making sense of abuse in two Latino families experiencing sibling incest. Participants included five male children ranging in age from 8 to 15 that were members of two families dealing with the issue of sibling incest. The purpose of this study was to build understanding of how families experience sibling incest and its role in their families. Clinical data from therapy sessions was analyzed to reveal that families made sense of the incest in different ways including abuse as normal and abuse as a mistake. Central concepts that explained how the families responded to the sibling incest included (1) level of family cohesion, (2) role of secrecy, and (3) view of outside systems. The findings suggest that treatment needs to include an in-depth assessment regarding these issues.     

Family therapy in Macau: development,challenges and opportunities

Family therapy in Macau is in its early stages of development. The Satir model and structural family therapy were the first two therapies introduced. Later on, solution‐focused brief therapy and narrative therapy were also introduced. Macau has been undergoing dramatic socioeconomic changes since the relaxation of the gambling licenses. In sociocultural terms this has led to significant changes: the so‐called ‘dealer's complex’, gambling, drug abuse and youth deviance have become more prevalent. To address complicated family problems, various counselling institutes and training centres were established to conduct family therapy. However, there are still some limitations and challenges that must be addressed in order to have a thriving family therapy profession in Macau.     

Engaging reluctant adolescents in family therapy: an exploratory study of in‐session processes of change

Informed by a trans‐theoretical model of the therapeutic alliance in conjoint family therapy, this exploratory study was the initial stage in a task analysis of critical shifts in adolescent engagement. Specifically, we compared sessions in which a resistant adolescent either did or did not shift from negative to positive engagement during the session. Two successful and two unsuccessful change events were selected from an archival data set based on SOFTA ratings of the therapeutic alliance. The results suggested that one parent element (support) and five therapist elements (structuring therapeutic conversations, fostering autonomy, building systemic awareness, rolling with resistance and understanding the adolescent's subjective experience) seemed critical for successfully facilitating adolescent engagement. The qualitative results were informed by the adolescent's self‐reported target complaints pretreatment, which suggested varying reasons for the teenagers’ active or passive disengagement. Implications for practice and recommendations for future research are offered to continue this line of inquiry.