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.     

Family Therapy in the Forbidden City: A Review of Chinese Journals From 1978 to 2006

This article provides a glimpse into the development of family therapy in China, by reviewing family therapy articles written in Chinese and published in journals in China that are not, therefore, readily accessible to the international community. A content analysis of journals published between 1978 and 2006 revealed 199 family therapy articles in 109 Chinese journals. Most of the studies were conducted by psychiatry or medical professionals, and were based on general systems theory or a systemic family therapy model. The articles focused on the promotion of family therapy theories and interventions in China, but did not specify the application of theory to specific clientele or symptoms. After the year 2000, a threefold increase in the number of family therapy publications was noted. These papers included the introduction of additional theories, but did not include critical assessment of the applicability of Western family therapy models to Chinese families. The researchers noted an absence of articles that identified Chinese approaches to family therapy, and a paucity of papers on gender, professional reflection, and the therapy process. The article concludes that there is room for improvement in the quality of family therapy publications in China, and that gains may be made by interdisciplinary collaboration among academics and practitioners.     

Family Secrecy in Family Therapy Practice: An Explorative Focus Group Study

The aim of this focus group study was to explore the experiences of family therapists working with family secrecy. Our study highlights that family secrets present important and compelling challenges for family therapists. Furthermore, our study reveals that there seem to be some basic strategies family therapists use in dealing with these challenges in therapy sessions. One basic strategy is that family therapists try to guard their position of being a trustworthy therapist for each family member by avoiding becoming stuck in family secrecy. Furthermore, therapists explore ways to guide the family toward the disclosure of the secret in order to alleviate the toxicity of the secrecy. This highlights the importance of the systemic model and how influential this perspective is in family therapy practice. Some participants, however, have in addition a second strategy they sometimes use: talking with the family about secrecy without aiming to disclose the secret. In the discussion section of the article we reflect on the possibility that in the strategic choices family therapists make conceptual issues might be involved. Furthermore, we stress the importance of further research.     

Evaluating Therapists' Practices in a Postmodern World: A Discussion and a Scheme

The social constructionist ideas currently reshaping the practice of family therapy are also relevant for supervision. However, if, as postmodernists assert, there is no privileged, expert position, how can supervisors evaluate their trainees? This question — a most pertinent one for university-based supervision, where evaluation is necessary and constant — is addressed both theoretically and pragmatically in this article. Ethical issues are explored, and an evaluation form, developed by the authors for use in a family therapy doctoral program, is presented and discussed.     

The Single-Case Design in Family Therapy Evaluation Research

This paper discusses the need for the development of new research designs for family therapy evaluation, and a manner for meeting that need. The single-case research design has gained acceptance as bona fide experimental designs for evaluating the effectiveness of intervention techniques in drug and psychotherapy outcome research. Although the need for more outcome studies on the effectiveness of family therapy has been frequently noted, there has been virtually no use of the single-case design in family therapy outside of the behavior modification literature on families. This paper presents potential benefits of the application of single case-design for the practice of family therapy. Preliminary guidelines are suggested for the application of these designs.     

Qualitative Research in Marriage and Family Therapy: Who is in the Interview?

Qualitative interviews are a rich means of gathering information from families. The qualitative interviewer has a choice of interviewing individual family members, multiple family members at the same time, or a combination. The configuration of interviewees is a choice guided by the epistemology of the researcher, research aims, and questions. This article reviews the literature on interviewing different configurations of family members. A content analysis was conducted on articles in the marriage and family therapy literature from 1990 to 2005. Over half of the articles were conducted with individual family members separate from their families. This finding is discussed in the context of the decision regarding whom to interview.     

Child-oriented family therapy in China: A cross-cultural application of integrative family therapy targeting children aged 4–10

This article describes child-oriented family therapy (COF), a family therapy approach to early psychological and behavioral problems that is widely applied in northern Europe and has been adopted by countries with different cultures, such as Germany and China. This article explains the theoretical background, setting, characteristics, development and effective factors of this method and explores relevant research. In addition, the application of this method in China and reflections on its applicability to families in different cultures are presented. A clinical case is provided to illustrate the core therapeutic principles of COF. Since the application of COF interventions to families with children in Asian cultures remains understudied, the widespread availability of COF and adaptation to local conditions could facilitate training and research achievements in this field.     

Is there evidence for the use of art therapy in treatment of psychosomatic disorders,eating disorders and crisis? A comparative study of two different systems for evaluation

A comparative study of two different systems for evaluation. Scandinavian Journal of Psychology 53, 47-53. As with any type of treatment the requirement for evidence based practice (EBP) has also affected art therapy (AT) when used as an intervention. This review evaluates the available evidence for using AT for psychosomatic disorders, eating disorders and crisis. The search in Cochrane, Best Practice, AMED, CINAHL, PION, PsycINFO and PubMed from 1987 until now resulted in a huge number of articles but only 32 articles met our criteria for evaluations. The articles were assessed with two evaluation systems, the GRADE system used by the Swedish Council on Health Technology Assessment (SBU) and the US Preventive Services Task Force (USPSTF/Task Force). When comparing the results we found that the GRADE evaluation system rejected the quality in 84% of the 32 studies and the USPSTF/Task Force 41% of these studies. An evidence base for AT was found only according to the criteria of USPSTF/Task Force. Hence, the evidence concept is not explicit, which means that effective treatments run a risk of not being implemented in health care. We suggest a broader view of what constitutes evidence in order to make it possible to include different types of research designs and methods.     

‘Defending the family,’ safeguarding the nation: an examination of evangelical mobilisation in present-day Barbados

This article addresses the connection between religion, culture and the family through a critical examination of evangelical Christians’ focus on ‘the family’ in Barbados, in 2015 and 2016. The intentions are to highlight Evangelical Christians’ strategic deployment of a common rhetoric or frame of ‘defending the family,’ which was put forward in public discourses relating to sex, sexuality, marriage and the family. This rhetoric draws upon and reproduces deep-seated anxieties around the state of the family as well as its connection to ideas of progress, freedoms, national sovereignty and the establishment of strong nations. The article also sheds sociological light on Evangelical mobilisations by exploring the socio-cultural context in which they are occurring. The presented analysis is based on a critical feminist discourse analysis of relevant local and regional newspaper articles, blogs and websites, observational research as well as a review of secondary qualitative and quantitative data and pre-existing scholarly literature.     

Thematic review of Family Therapy Journals 2012

In this article the contents of the principal English‐language family therapy journals, and key family therapy articles published in other journals in 2012 are reviewed under these headings: therapy processes in the treatment of child‐focused problems, autism, adolescent substance use, human immunodeficiency virus, depression and grief, fragile families, mental health recovery, medical family therapy, family business and systemic practice, couple therapy, intimate partner violence, key issues in theory and practice, research, diversity, international perspectives, interviews, and deaths.     

Couple and Family Treatments: Study Quality and Level of Evidence

This paper examines the application of the guidelines for evidence‐based treatments in family therapy developed by Sexton and collaborators to a set of treatment models. These guidelines classify the models using criteria that take into account the distinctive features of couple and family treatments. A two‐step approach was taken: (1) The quality of each of the studies supporting the treatment models was assessed according to a list of ad hoc core criteria; (2) the level of evidence of each treatment model was determined using the guidelines. To reflect the stages of empirical validation present in the literature, nine models were selected: three models each with high, moderate, and low levels of empirical validation, determined by the number of randomized clinical trials (RCTs). The quality ratings highlighted the strengths and limitations of each of the studies that provided evidence backing the treatment models. The classification by level of evidence indicated that four of the models were level III, “evidence‐based” treatments; one was a level II, “evidence‐informed treatment with promising preliminary evidence‐based results”; and four were level I, “evidence‐informed” treatments. Using the guidelines helped identify treatments that are solid in terms of not only the number of RCTs but also the quality of the evidence supporting the efficacy of a given treatment. From a research perspective, this analysis highlighted areas to be addressed before some models can move up to a higher level of evidence. From a clinical perspective, the guidelines can help identify the models whose studies have produced clinically relevant results.     

Medical Family Therapy: A Theoretical and Empirical Review

Medical Family Therapy (MedFT) is a relatively young sub-specialty founded initially at the intersection of Family Therapy and Family Medicine. The purpose of this article is to synthesize and review scholarly literature covering almost 30?years of history, growth, and available research on MedFT. Eighty-two articles that met specific inclusion criteria were reviewed and the literature was categorized into four distinct themes: (a) Emergence of MedFT in the literature; (b) Contemporary MedFT skills and applications; (c) Punctuating the ??family therapy?? in MedFT; and (d) MedFT effectiveness and efficacy research. What was learned was that MedFT is growing so rapidly there is now a need for a current definition, identification of core curriculum standards and competencies for training, as well as a commitment to produce rigorous research on its effectiveness and efficacy. Recommendations to advance efforts across the foci are provided.     

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.     

An evaluation of the quantity and quality of empirical research in three pastoral care and counseling journals, 1990-1999: has anything changed?

This article summarizes a review of all articles published in Pastoral Psychology, The Journal of Rleigion and Health, and The Journal of Pastoral Care between 1900 and 1999, identifying a total of 737 scholarly articles, of which 165 (22.4%) were research studies. The proportion of research studies, especially quantitative studies, increased significantly between the first and second half of the study period (p < .05). There was a significant positive correlation between compliance with three out of four criteria of internal validity. Three of five criteria of external validity were also positively related to one another. Compared to previous research using identical criteria to assess quantitative studies in the same journals in 1980-1989, the 1990-1999 sample showed improved compliance with respect to specifying the sampling method (p < .001), reporting the response rate (p < .05), and discussing the limitations of research studies (p < .001). However, the overall findings suggest that many researchers in the field do not have a sophisticated knowledge of statistical sampling, statistical analysis, or research design. Several recommendations for increasing the quality of quantitative research are offered.     

Entre Nosotros: Exploring Latino Diversity in Family Therapy Literature

The term Latino is often used to describe a largely diverse group of individuals living in the United States. This very broad term minimizes within-group differences due to race, ethnicity, class, country of origin and impact of immigration. We conducted a content analysis of 78 articles from peer reviewed journals in the fields of family therapy and family studies focused on Latinos, published from 2000 to May 2010, to challenge the Theoretical Myth of Sameness. We describe our evaluation and offer a culturally sensitive clinical and research approach with Latinos.     

Psychotherapeuten und ihre psychischen Probleme

A cliché about psychotherapists, psychologists and psychiatrists is that they themselves apparently all have mental problems. This review article analyzes the state of research on the topic based on a databank search in PubMed using the terms “(mental disorders OR suicide) AND (psychologists OR psychiatrists OR therapists OR psychoanalysts)” and an analysis of relevant review articles. In the databank search only ten publications were identified which related to any mental problems of therapists. These partially confirmed an increased risk of suicide, increased mental problems, such as depression, increased burnout risk and increased problems in childhood (e.g. sexual abuse and parentification) and showed that research deficits clearly exist. With respect to coping with such risks, the topics training therapy, personal therapy, self-care, and additional opportunities are discussed. In conclusion the implications for research and practice are discussed.     

Review and reflections on 40 years of family therapy development in Taiwan

Although the systemic approach is considered to fit Chinese culture, the development of family therapy in Taiwan is recent, starting in 1969, and growing as a treatment modality in Taiwan for the past two decades. To examine this development, this article reviewed 127 locally published family therapy studies published during the years 1969–2009. Content analysis was used to examine these articles and the results clearly showed an increase in the amount of publications during this period. The focus of the studies also shifted from theoretical issues to practical concerns. An analysis of 15 of these articles, which were case reports, suggested a preference for local common practice, for example, a focus on therapist manoeuvres rather than the clients' perspectives, which might have hindered the development of successful practice. The availability of only certain forms of training might also have contributed to the clinical focus of family therapy in Taiwan. The article suggests that greater interest in the therapy process in future will enhance local practitioners' clinical efficacy.     

A Systematic Review of Quality of Life Measures in Pregnant and Postpartum Mothers

Quality of life has emerged as an essential health component that broadens the traditionally narrow concerns focused on only morbidity and life expectancy. Although a growing number of tools to measure quality of life are in circulation, there is a lack of guidelines as well as rigorous assessment for their use with pregnant and postpartum populations. It is also unclear whether these instruments could validly be employed to measure patient-reported outcomes in comparative effectiveness research of maternal care interventions. This paper reviews articles cited in CINAHL, COCHRANE, EMBASE, PSYCINFO, and PUBMED that addressed quality of life in pregnant and postpartum populations. Instruments used to measure quality of life in selected articles were assessed for their adherence to international guidelines for health outcomes instrument development and validation. The authors identified 129 articles that addressed quality of life in pregnant and/or postpartum women. Out of these, only 64 quality (generic and specific) scales were judged relevant to be included in this study. Analysis of measurement scales used in the pregnant and/or postpartum populations revealed important validity, reliability and psychometric inadequacies that negate their use in comparative effectiveness analysis in pregnant and post-partum populations. Valid, reliable, and responsive instruments to measure patient-reported outcomes in pregnant and postpartum populations are lacking. To demonstrate the effectiveness of various treatment and prevention programs, future research to develop and validate a robust and responsive quality of life measurement scale in pregnant and postpartum populations is needed.     

Family Science in the Context of the COVID-19 Pandemic: Solutions and New Directions

The coronavirus disease 2019 (COVID-19) pandemic has precipitated substantial global disruption and will continue to pose major challenges. In recognition of the challenges currently faced by family scientists, we share our perspectives about conducting family research in the context of the COVID-19 pandemic. There are two primary issues we address in this article. First, we present a range of potential solutions to challenges in research, resulting from the pandemic, and discuss strategies for preserving ongoing research efforts. We discuss approaches to scaling back existing protocols, share ideas for adapting laboratory-based measures for online administration (e.g., using video chat platforms), and suggest strategies for addressing missing data and reduced sample size due to lower participation rates and funding restrictions. We also discuss the importance of measuring COVID-19 relevant factors to use as controls or explore as moderators of primary hypotheses. Second, we discuss how the COVID-19 pandemic represents a scientifically important context for understanding how families adjust and adapt to change and adversity. Increased stress precipitated by the pandemic, varying from acute stress associated with job loss to more chronic and enduring stress, will undoubtedly take a toll. We discuss ways that family scientists can contribute to pandemic-related research to promote optimal family functioning and protect the health of family members.     

Who Reads Outcome Research?

To explore patterns of outcome research consumption, we conducted a national survey of 313 family therapists currently practicing in the United States. Participants were asked about their reading practices, as well as about attitudes toward and barriers to reading marriage/couple and family therapy (M/CFT) outcome research. Results suggest that most therapists perceive outcome research as at least somewhat important. However, they spend relatively little time reading it: The average is 1.7?h per month. Therapist-identified barriers to reading outcome research articles include access, applicability, quality of writing, and quality of research. Recommendations for addressing some of these barriers are offered.