A Critical Methodological Review of Discourse and Conversation Analysis Studies of Family Therapy

Discourse (DA) and conversation (CA) analysis, two qualitative research methods, have been recently suggested as potentially promising for the study of family therapy due to common epistemological adherences and their potential for an in situ study of therapeutic dialog. However, to date, there is no systematic methodological review of the few existing DA and CA studies of family therapy. This study aims at addressing this lack by critically reviewing published DA and CA studies of family therapy on methodological grounds. Twenty‐eight articles in total are reviewed in relation to certain methodological axes identified in the relevant literature. These include choice of method, framing of research question(s), data/sampling, type of analysis, epistemological perspective, content/type of knowledge claims, and attendance to criteria for good quality practice. It is argued that the reviewed studies show “glimpses” of the methods’ potential for family therapy research despite the identification of certain “shortcomings” regarding their methodological rigor. These include unclearly framed research questions and the predominance of case study designs. They also include inconsistencies between choice of method, stated or unstated epistemological orientations and knowledge claims, and limited attendance to criteria for good quality practice. In conclusion, it is argued that DA and CA can add to the existing quantitative and qualitative methods for family therapy research. They can both offer unique ways for a detailed study of the actual therapeutic dialog, provided that future attempts strive for a methodologically rigorous practice and against their uncritical deployment.     

Five Phases of Dyadic Analysis: Stretching the Boundaries of Understanding of Family Relationships

In the last decade, an increasing number of qualitative studies sought to investigate the dynamics of various dyads by conducting in-depth, multiple family member interviews. The emphasis in the methodological literature dealing with this type of research is primarily on the data collection process, and much less on the development of methods suitable for the analysis of the data thus derived, especially with regard to dyads consisting of family members belonging to different systems: families of origin or nuclear families. The purpose of this paper is to propose a model for dyadic analysis based on examining the dynamics of the evolving relationships between key caregivers of a family member with brain injury. The model includes inductive and abductive phases of analysis, and it is based on an ecological-systemic perspective. The benefits of this model are highlighted, and its potential contribution is further discussed.     

Clinical Supervision of Couple and Family Therapy during COVID-19

This paper addresses the need for a swift transition from in-person clinical supervision to telesupervision during the time of the COVID-19 global pandemic. Five specific areas will be discussed in the effort to enhance the quality of clinical supervision provided to couple and family therapists in training at this time including the following: (1) COVID-19 and the structural changes and technological adaptation of supervision; (2) culturally and contextually sensitive guidelines for clinical supervision during COVID-19; (3) the supervisee’s competence and the clinical supervisory process; (4) the new set of boundaries and the supervisory role; (5) and the supervisory alliance and supervisees’ vulnerabilities in the face of COVID-19.     

The Italian Version of SCORE-15: Validation and Potential Use

SCORE-15 (Systemic Clinical Outcome and Routine Evaluation) is a 15-item questionnaire for completion by family members aged 12 years and older to assess outcomes in systemic therapy. This study aimed to investigate (a) the psychometric properties and the internal consistency reliability of the Italian version of SCORE-15, (b) clinical responsiveness, and (c) normative (Italian) criteria. Furthermore, (d) the study sought to evaluate the participants’ representation of both their family and their problems, analyzing open-ended questions included in the SCORE-15. Data were collected from two clinical centers for 208 families (n = 507). Results confirmed the three-factor structure (i.e., strengths, difficulties, and communication), a good internal consistency reliability, and indicated a cutoff threshold for the Italian version. Furthermore, results showed that SCORE-15 is a good instrument for clinical responsiveness and that it can be used to explore the way in which family members describe their families and problems. Overall, SCORE-15 is a brief, psychometrically robust family assessment instrument that may be used for both researchers and practitioners in several domains of clinical and social psychology.     

A Task Analysis of Client Re-engagement: Therapeutic De-escalation of High-Conflict Coparents

Parents who are engaged in protracted conflict following a divorce are often referred to coparenting therapy. Episodes of intense conflict are common during these therapy sessions and often result in coparents disengaging from the therapist while they engage in escalating conflict with each other, potentially disrupting their progress in therapy. The purpose of this study was to identify how therapists successfully re-engage clients in the session. To understand this process, 24 disengagement events (12 successful and 12 unsuccessful) from 13 cases were analyzed using a task analytic approach. The sample included coparent dyads referred by the judicial system to a high-conflict coparenting therapy program. Task analysis was used to create a model of how re-engagement unfolds in treatment. The empirical model that resulted has five phases: (1) disengagement from the therapeutic process, (2) disruption of the conflict, (3) de-escalating the most escalated coparent, (4) de-escalating the other coparent, and (5) therapist buffered re-engagement. Successful episodes of re-engagement tended to have therapists who remained active throughout the conflict episode, used structuring interventions aimed at disrupting and then regulating the most escalated partner, blocked attempts to re-engage in conflict, and then repeated this process with the less escalated partner. Additional interventions that promote therapeutic re-engagement are described for each phase, and implications for clinicians and researchers are discussed.     

Barriers and Facilitators to Implementing Attachment-based Family Therapy into a Child Welfare Setting: A Qualitative Process Evaluation

Child welfare systems (CWSs) worldwide show increased interest in adopting empirically informed clinical strategies to increase treatment effectiveness. Many empirically supported treatments (ESTs) exist, but little is known about EST implementation barriers and facilitators in CWS. This study explored CWS providers’ experiences of implementing attachment-based family therapy (ABFT) in home-based services of the Flemish CWS (in Belgium). Sixteen CWS providers (twelve counselors and four supervisors) involved in three home-based services were interviewed. The Consolidated Framework for Implementation Research (CFIR) was used to guide collection, coding, and analysis of interview data. Findings revealed that implementation success was related to ABFT's fit with the CWS's mission, philosophy, and existing practices. CWS providers’ belief in the compatibility between ABFT and CWS increased investment in implementation efforts and persistence to overcome challenges and setbacks. Some barriers pertained to the learning of ABFT and some barriers pertained to systems level challenges such as lack of leadership and support, poor coordination with referral sources and other youth care partners, and lack of policy support. For successful expansion of ESTs into CWS settings, various barriers at multiple systemic levels need to be addressed.     

Outsider Witness Groups as a Means of Professional Growth in Family Therapy Training: An Exploratory Qualitative Study

This exploratory qualitative study examines the experiences and meanings associated with family therapy trainees’ participation in the narrative practice of Outsider Witness Groups (OWG). At the Barcai Institute in Tel Aviv, we incorporate OWGs into our live clinical supervision courses. In some sessions, we offer the families undergoing therapy the opportunity to listen to the reflections of the group of trainees regarding what they witnessed during the session. Twenty-nine family therapy trainees participated in the study in five focus group interviews. Analysis of the interviews yielded four core themes regarding the trainees’ experiences: (i) Exploring the stance of the therapist; (ii) The art of listening; (iii) Reflection on hierarchy and boundary setting; and (iv) Negotiating self-disclosure. The findings indicate that family therapy trainees stand to benefit significantly in their professional journey, development, and growth from integrating OWG practices into their training. OWG fosters the development of critical reflectivity in trainees, including the deconstruction of common and taken-for-granted assumptions. It also fosters practices related to family therapy, and perhaps also to therapy in general. The findings also suggest that taking part in OWGs during training may contribute to family therapy trainees’ development of critical reflectivity as a means of introducing a more critical and political approach to therapy and developing their own preferred stories as therapists.     

Conversation Orientation Moderates the Relationship between Information Sharing of Medically Assisted Reproduction and Child Adjustment

Parents who experienced infertility have increasingly used medically assisted reproduction (MAR) to add children to their families over the past few decades. These parents will need to decide if they will tell their children about being conceived using MAR. Although MAR information sharing operates within family contexts, little is known about the role of conversation orientation—one family contextual factor—in child outcomes associated with MAR information sharing in middle childhood. Derived from the Family Communication Patterns Theory, this study proposes that conversation orientation moderates the associations between MAR information sharing and children's psychosocial adjustment. This proposal was tested using a sample of 81 6- to 12-year-old MAR-conceived children from 55 families and a structured observational measure of conversation orientation. Multiple regression analyses showed that MAR information sharing interacted with conversation orientation to influence children's behavioral and attention problems but not emotional problems. In families with high conversation orientation, MAR information sharing was not significantly associated with children's behavioral and attention problems. In families with low conversation orientation, MAR information sharing was significantly associated with an increase in children's behavioral and attention problems. Results of this exploratory study demonstrate the potential significance of general communication orientation in understanding child outcomes of MAR information sharing and highlight the needed family context nuances in MAR research.     

Sitting In: The Experience of Learning and Practicing Family Therapy through Being a Co-Therapist in Hong Kong

This article explores family therapy trainees’ subjective experiences of working as cotherapists with a supervisory-level therapist in a Chinese context, regarding their perceptions of and positioning in it and also their opinions on the benefits and/or pitfalls of cotherapy. Individual interviews with a total of six cotherapists revealed three themes: (1) Cotherapy was perceived as an experiential learning journey that evolved from anxiety and excitement to empowerment and nurturing; (2) a collaborative master–apprentice relationship of openness, trust, and mutual respect was developed with both sides’ interactive effort, which included common commitment and concern for the client, the supervisor’s awareness and explicit address of the role hierarchy, principle setting prior to the cooperation, and honest pre- and-postsession sharing and discussion; (3) the dual-purpose supervisor–trainee cotherapy brought direct benefits for all involved parties and for others. The findings have useful implications for integrating treatment and training for optimal training/learning outcomes and for advancing knowledge transfer from senior to junior and from academia to the field, with reference to local cultural characteristics.     

Entrevista con Klaus R. Scherer

RESUMEN

El profesor Scherer es uno de los Psicólogos Sociales más importantes de la actualidad, un importante investigador en temas de psicoacústica o de la conducta no verbal no vocal (como a él le gusta llamar a su campo). La contribución del profesor Scherer a la investigación del análisis psicológico de la voz y de las relaciones entre personalidad y los sitemas vocales no verbales de la comunicación ha sido muy importante para el desarrollo de la investigación en la dimensión no-verbal de la conducta. En esta entrevista Scherer reflexiona sobre el pasado y presente de la psicología alemana, refleja los hitos principales de su área de estudio y plantea el problema de la responsabilidad del investigador en la aplicación de sus hallazgos y productos. Se presenta, en esta entrevista, un ejemplo esclarecedor de la importancia de los factores interdisciplinarios en la génesis y apertura de nuevas áreas para la investigación.     

Scene-Based Psychodramatic Family Therapy With Troubled Adolescents and Parents: A Pilot Study

Scene-Based Psychodramatic Family Therapy (SB-PFT) is an innovative treatment used with troubled adolescents and their parents to improve family relationships and reduce adolescents’ problematic behavior. It integrates the principles of family therapy, psychodrama, and multiple-family group methodology. This research is a pilot study to obtain empirical evidence on the SB-PFT therapeutic process by gauging the perception of change of troubled adolescents and their parents, and assess the perceived helpfulness of its methodology and techniques. Ten multiple-family intervention groups were drawn up, with 110 participants (63 adolescents and 47 parents), and we adopted a qualitative methodology with focus groups, using an inductive analysis of 290 active constructions of participant narratives. Concerning perception of change, the adolescents reported mainly gaining in social support, prosocial attitudes, keys to problem solving, and expression of emotions due to the treatment. The parents perceived improvement in social support, keys for educational practices, emotional well-being, and expression of emotions due to the treatment. Regarding the perceived helpfulness of methodology and techniques, both adolescents and parents highlighted the usefulness of the group methodology for gaining social support, relativizing the problem, and expressing emotions. Additionally, participants referred to role-playing and mirror techniques as the most useful techniques. In conclusion, this first study on SB-PFT presents and describes its treatment for troubled adolescents and their parents. The participants’ positive perception of their personal and relational change after treatment should serve to promote further studies with quantitative methodology in order to verify the effectiveness of SB-PFT treatment.     

Behind the (Virtual) Mirror: Online Live Supervision in Couple and Family Therapy

Online therapy and supervision, a rapidly rising practice in couple and family therapy, has been the subject of a growing body of literature. From its early days, family therapy training has included live supervision, which has typically been conducted by a supervisor and a team of trainees situated on the other side of a one-way mirror. With the outbreak of the COVID-19 global pandemic, we—the staff of supervisors at the Barcai Institute in Tel Aviv, Israel—were compelled to find solutions to continue meeting with clients and to provide supervision for family therapy trainees. To this end, we have shifted our live supervision courses (“practicums”) to the virtual arena, adapting the popular application “Zoom” into what we call “PractiZoom.” Based on over 100 PractiZoom sessions conducted between March and May 2020, involving 14 supervisors and 28 therapists-in-training and their clients, the article reflects on this pioneering online practicum for the online live supervision of therapists with geographically distributed participants. In this article, we outline our operational methods and adaptations for conducting live behind-the-mirror supervision online. Following a short theoretical background, we outline the process of online live supervision, discuss our reflections and those of our trainees on the challenges and possibilities it poses, and offer a number of preliminary conclusions and recommendations.     

Exploring Exceptions and Discovering Solutions: A Case Presentation of Autism and the Family

As the prevalence of autism spectrum disorder (ASD) continues to rise, there is a rapidly increasing need for treatment services among individuals diagnosed with ASD and families. Currently, the majority of the evidence-based treatments, such as Applied Behavior Analysis, overlook the notable systemic effects of ASD and maintain a problem-focused lens. There is a growing body of research calling for strength-based, relational interventions that build on existing resources to enhance coping, efficacy, and well-being among families affected by ASD. Solution-Focused Brief Therapy (SFBT) is a widely practiced clinical approach that is increasingly being used among clinicians to address the systemic effects of developmental disabilities in the family. However, particular modifications to specific interventions may better accommodate autism-associated deficits in executive functioning (e.g., goal development and impulsivity), perspective taking, or restricted interests when using an SFBT approach. This article offers recommendations for adapting a solution-focused approach by modifying commonly used SFBT interventions to address family-driven treatment goals using a collaborative stance with families of children with ASD. A case presentation is included to demonstrate SFBT as informed by the unique challenges and inherent resources of families affected by ASD that have been identified in the extant literature.     

Lessons from the Transition to Relational Teletherapy During COVID-19

When the World Health Organization declared the coronavirus outbreak a pandemic, clinicians were challenged to maintain continuity of care. Teletherapy became the primary means of service delivery for many who had never or only sparingly used it. The Family Institute at Northwestern University, in response to encouraging findings with respect to the effectiveness of teletherapy and recognizing advantages with respect to access to care, launched our teletherapy services in 2018. As a relationship-based organization, we were keen to exploit the opportunity that teletherapy provides to integrate additional members of the client system into the treatment. Over these two plus years, we have learned a great deal. Our learning was greatly accelerated by our transition to a 100% teletherapy practice in the wake of the pandemic. Teletherapy is a different context. Intentionally managing the context’s constraints and exploiting its strengths is key to providing high-quality couple and family therapy. This step is often overlooked or resisted when teletherapy is an occasional add-on to a face-to-face practice.     

Therapist Interventions Associated with Productive Emotional Processing in the Context of Attachment-Based Family Therapy for Depressed and Suicidal Adolescents

Productive emotional processing is considered a key change mechanism in attachment-based family therapy (ABFT). This study examined the impact of attachment-based family therapy therapist interventions aimed to promote productive emotional processing of primary adaptive emotions in a sample of 30 depressed and suicidal adolescents who had participated in a larger randomized clinical trial. Results of sequential analyses revealed that relational reframes and therapists’ focus on primary adaptive emotions were associated with the subsequent initiation of adolescents’ productive emotional processing of primary adaptive emotions. In contrast, interpretations, reassurances, and therapists’ focus on adolescents’ rejecting anger toward their parents were all followed by the discontinuation of adolescents’ emotional processing that had already begun. Finally, therapists’ general encouragement of affect and focus on adolescents’ unmet attachment/identity needs were associated with both the initiation of adolescents’ productive emotional processing, and with the discontinuation of such processing once it had already begun. Theoretical and clinical implications are discussed.     

The Critical Need to Recognize That Families Matter for Adult Health: A Systematic Review of the Literature

A systemic approach to researching families and health should capture the complex network within which family members are embedded, including multiple family relationships and larger systems of health care. However, much of the families and health research focused on adult family members has focused solely on intimate partnerships, usually the marital relationship. This neglects the remainder of the powerfully influencing family relationships adults retain, and may increasingly focus on as they age. We conducted a systematic review of the families and adult health literature, retaining 72 articles which were subsequently thematically coded to highlight main foci of this area of research. Results highlight six themes, which include family relationship quality, family composition, behavioral factors in health and health care, psychophysiological mediators, caregiving, and aging health. Findings support an underrepresentation of family members, other than the intimate partner, in research on adult health.     

Q-Coh: A tool to screen the methodological quality of cohort studies in systematic reviews and meta-analyses

The evaluation of the methodological quality of primary studies in a systematic review is a key process to enhance the likelihood of achieving valid results. When considering non-randomized designs as cohort studies, this process becomes even more critical, since these designs are more susceptible to bias than randomized controlled trials are. Taking this into account, a tool, named Q-Coh, was designed with the aim to screen the methodological quality of the primary studies with a cohort design priming specificity over sensitivity in a reasonable application time. After applying it to 21 prospective cohort studies by three raters, all domains had a moderate to good agreement, with all except one of them having statistically significant kappa values. Despite there is no gold standard for the methodological quality, arguments supporting its validity are given. Future research should assess the psychometric properties of Q-Coh in the context of real meta-analyses, evaluate the influence of the raters’ substantive and methodological expertise on these properties, and explore different ways of including the domains-based ratings of the quality provided by Q-Coh into meta-analyses.