The Practice of Suicide Assessment and Management by Marriage and Family Therapists

Abstract

Over 90% of mental health providers encounter suicidal clients. However, the majority of marriage and family therapists (MFTs) are not exposed to suicide-specific trainings within their clinical coursework. Due to the lack of consistent training protocols for suicide assessment and management among MFTs, this qualitative study identified common MFT responses to suicidal clients, including assessment of risk severity and intervention modalities. Responses were then compared to best practices for suicidal clients. Participants inconsistently adhered to best practices identified in the larger field of mental health, revealing the need for increased MFT training on suicide to ensure appropriate and effective care.     

Marital Problems Occurring in Midlife: Implications for Couples Therapists

The ability of therapists to adequately address the presenting problems of couples impacts the process and outcome of therapy. Although research has examined the types of problems that couples commonly experience, little is known about problems among midlife couples. Midlife marital problems were examined using data from a national random sample of 632 married people between the ages of 40 and 50. The results indicated that the most common problems were financial matters, ways of dealing with children, and sexual issues. Values, commitment, spiritual matters, and violence were the least common problem areas. There were few differences when gender, remarriage, and length of marriage were considered.     

Marriage and Family Therapists’ Use and Comfort with Online Communication with Clients

Despite the growth in computer and Internet use, marriage and family therapists’ (MFT) use of such technologies to communicate with clients has received limited attention. The purpose of the current research was to understand the frequency and ways in which MFTs are communicating online with clients and identify their level of comfort with online treatments. We administered a survey to practicing MFTs across the US to identify the frequency with which they used online communications with their clients, and the extent to which they felt comfortable using online communications in various treatment modalities. Implications for research, training, and practice are discussed.     

Let’s Play: Using Systemic and Experiential Techniques in the Play Therapy Instruction of MFT Masters’ Students

Marriage and family therapists are uniquely poised to work with entire families, including children. It is surprising then, that so few MFTs affiliate with play therapy. Many COAMFTE accredited masters’ programs offer some form of play therapy training, but therapists often report feeling uncomfortable with play therapy (Gil, 2015). In this paper, we offer a condensed refresher course on play therapy for MFTs, including suggested readings, materials, and instructions to expand training from a 2-day seminar to a 14-week course. We discuss the strengths and weaknesses of offering play therapy instruction as a semester long required course for masters’ students.     

Ethics for Mental Health Influencers: MFTs as Public Social Media Personalities

The increase in social media usage contributes to a greater number of Marriage and Family Therapists (MFTs) using social media to grow their professional outreach and to increase awareness about mental health by engaging with online audiences. Although existing literature has discussed how MFTs can make ethical use of personal social media in and around their therapeutic role, no literature at this time has explored the potential ethical issues faced by MFTs seeking to build public presence on social media as a “mental health influencer.” The present paper intends to provide a definition of mental health influencers (MHIs) and reviews ethical concerns relevant to MFTs acting as MHIs. Particular consideration is given to ethical dilemmas and conflicts-of-interest which may emerge via parasocial relationships developed through social media influencing, as well as how the boundaries and the limitations of an MFT’s professional scope can be tested when presenting as a personable, public figure over digital platforms. A framework for conceptualizing ethical issues for MHI-MFTs is offered, with a selection of prescient issues being examined within the scope of existing ethical standards set forth by the American Association of Marriage and Family Therapy’s (AAMFT) Code of Ethics. Reflections are offered about what questions and guidelines should be observed by MFTs in order to avoid unethical use of social media as an MHI, followed by a brief discussion about future considerations which should be considered by MHIs.

     

Resisting Abuse at What Cost? The Impact of Mandated Reporting Laws on the Process and Content of Therapy

Child abuse reporting is mandatory for family therapists. Little is written regarding the impact of mandated reporting and its impact on the family therapy systemic processes. This paper reviews literature on the impact on therapy of mandated reporting, and shares the results of a study designed to assess the impact of mandated reporting on family therapist's attention to systemic issues. The study demonstrates that MFTs shift their focus when the question of a mandated report arises to the detriment of systemic considerations. The institutional split between investigation and treatment of child abuse is discussed.     

Tainted therapy and mistaken memory: Avoiding malpractice and preserving evidence with possible adult victims of childhood sexual abuse

Recent malpractice cases reflect increased liability for psychotherapists working with possible adult victims of childhood sexual abuse. These cases have related to recovery of past memory of abuse and the fashion in which the therapist managed the recovery and treatment. Ways in which therapists may harm clients by omission and commission are explored. The emerging lack of clarity between investigative and therapeutic interviews is discussed. False memory is considered in relationship to malpractice liability, standards of care, and attempts to preserve potential evidence. The author proposes written informed consent and investigative interviewing procedures for working with potential memory recovery cases. Formats for general informed consent to psychotherapy for patient record keeping of newly emergent material are appended.     

Remembering the Pattern that Connects: Toward an Eco-Informed MFT

Gregory Bateson, who is regarded as one of the founders of the field of family therapy, warned about the dangers of chopping up the ecology (literally and metaphorically). Yet the ecosystem is showing signs of faltering under the pressure of human mistreatment, and increasingly people are manifesting symptoms associated with extreme disconnection from nature. Although family therapists have devoted little attention to the relationship between human and ecological planetary suffering, as systemically trained professionals MFTs are uniquely situated to see the big picture and to promote integrative healing between individual, familial, and environmental levels. This article explores some of the factors underpinning the field’s lack of attention to ecological issues and provides recommendations for how MFTs can remember the pattern that connects by cultivating a more eco-informed approach to training and clinical practice.     

A Systemic Treatment of Families with a Child Diagnosed with Autism Spectrum Disorder Using a Narrative Lens

Abstract

Autism Spectrum Disorder (ASD) is a neurodevelopment disorder that now affects one in 59 children, a 15% increase from the 2012 report. Although there have been numerous studies on the treatment of ASD, interventions focus primarily on the individual diagnosed with ASD. Marriage and family therapists’ (MFT) are in a unique position to handle the systemic dynamics of ASD. As a result, many MFTs find it difficult and outside their scope of practice to work with these families. We will explore aspects of narrative family therapy, conceptualization, and interventions, giving the reader a base understanding of how to implement narrative therapy while working with this population.     

The Relationship of Differentiation,Family Coping Skills,and Family Functioning with Optimism in College-Age Students

The marriage and family therapy (MFT) field would benefit from new research about positive subjective experiences, such as optimism, in order to construct and nurture strengths for developing more positive emotions. Through a better understanding of optimism, marriage and family therapists (MFTs) can explore which strategies might help families and individuals better cope with distressing emotions by building buffering strengths. In this study we address the relationship of differentiation, family coping, and family functioning to optimism. We found that differentiation, family coping, and family functioning each have a significant effect on attributional style. The results of this study also indicated that encouraging clients to take an I-position and to reframe problems, in particular, may lead to greater optimism. This study contributes to the lack of research regarding strength-based theories in the MFT field.     

Comment

ABSTRACT

Comments on the role of greed at all levels of the managed care system, from individual patients to corporations. It is suggested that couples therapists not seek inclusion as “health care providers.”     

The use of altruism and forgiveness in therapy

This study investigates the relative likelihood of psychotherapists promoting altruism and forgiveness as therapeutic agents as compared with other techniques. One hundred and five therapists were asked to rate the relative likelihood of fostering altruism, forgiveness, direct expression of feelings, vicarious ventilation of feelings, and self-reinforcement in response to treating four presenting problems where a fictitious client had been hurt by another. Results indicated that, for the most part, altruism and forgiveness were likely to be promoted significantly less often than the other three therapeutic alternatives by the therapists sampled. The association of altruism and forgiveness with religious values and their disassociation from selftheory are posited as possible explanations for the findings.     

Can MFTs Address Spirituality with Clients in Publically Funded Agencies?

Many marriage and family therapy (MFT) trainees and therapists working toward licensure are accumulating hours in publically funded treatment centers. The increasingly diverse clientele in the U.S. likely will be served in the public sector, especially as many states are providing more funding for county agencies and increased tuition reimbursement and/or loan forgiveness for students and graduates who work for these organizations. MFTs may feel ill-equipped to address spiritual issues in therapy at these sites, especially when grappling with ethical concerns. This article delineates a case example in which an MFT attends to spiritual issues when working with a family in a county mental health center. The authors illustrate how a therapist can navigate the ethical dilemmas of this case when working from a Bowenian perspective.     

Unraveling subjects' perceptions of paraprofessionals and professionals: a pilot study

This study examined 75 undergraduate women's perceptions of paraprofessional and professional therapists in an analogy study. The data indicated subjects were more willing to seek treatment from paraprofessional than professional therapists; no differences were found in predicted success of treatment. Subjects' perceptions of paraprofessional and professional expertness, attractiveness, and trustworthiness were also examined; the findings were nonsignificant.     

Infant mental health home visiting therapists’ fidelity to the Michigan IMH-HV model in community practice settings

Implementation research suggests that fidelity to a therapeutic model is important for enhancing outcomes, yet can be difficult to achieve in community practice settings. Furthermore, few published studies have reported on characteristics of treatment fidelity. The present study examined fidelity to the Infant Mental Health Home Visiting (IMH-HV) model among 51 therapists with a range of experience practicing in community settings across the state of Michigan. IMH therapists completed fidelity checklists after every session with participating families to track use of 15 treatment strategies central to the IMH-HV model across the 12-month study period. Results indicated that the most commonly endorsed components utilized in home visits were developmental guidance and infant–parent psychotherapy, followed by the provision of emotional support. Use of IMH-HV components did not vary over time for the entire sample; however, patterns of strategies used showed somewhat more variability among more experienced therapists and when serving higher risk families. Findings demonstrate that IMH-HV therapists report a range of adherence to the model in community settings, with greatest fidelity to several model core components. Ongoing training in the flexible use of all core strategies may further enhance fidelity and contribute to positive outcomes for caregivers and their children receiving IMH-HV services.     

Parent Perspectives of an Evidence-Based Intervention for Children with Autism Served in Community Mental Health Clinics

Research suggests that improvements to community mental health (CMH) care for children with autism spectrum disorders (ASD) are needed. Recent research examining the feasibility of training CMH therapists to deliver a package of evidence-based practice intervention strategies (EBPs) targeting challenging behaviors for school-age children with ASD offers initial support for such efforts to improve care. Specifically, quantitative data from a recent pilot study indicate that CMH therapists with limited ASD experience can deliver an EBP intervention with fidelity and perceive it as useful to their practice. Further, client attendance is high and children demonstrate improvement on standardized measures. To further understand the feasibility and impact of training CMH therapists to deliver EBPs, this mixed-methods study examined parent perspectives of the process and impact of outpatient psychotherapy for 13 parents of children ages 5–13 with ASD whose therapists were trained to deliver the EBP intervention. Results complement and expand previously reported quantitative data on psychotherapy process indicating that parents are highly involved in treatment for their children, perceive a strong therapeutic alliance with their children’s therapist, and highlight that treatment was different once therapists began delivering the intervention. Results also indicate themes related to parents’ perceptions of positive child and parent outcomes that provide important details on the specific gains that were observed during treatment. Study findings underscore the importance of parent perspectives in understanding the process and impact of implementing EBPs in CMH settings for families of children with ASD.     

Therapists’ experiences with internal representations of clients

Fourteen therapists were interviewed via telephone regarding their experience of “carrying around” their clients with them between sessions (i.e. internal representations, or IRs, of clients), a phenomenon about which little empirically based knowledge exists. Data were analyzed using consensual qualitative research. Findings indicated that overall, therapists have IRs infrequently, most often have IRs of clients struggling with severe or challenging presenting problems, and do receive some training about IRs. When describing a specific IR experience, therapists typically noted a strong therapy relationship, and stated that the IRs typically had specific triggers. The IRs generally consisted of feelings about the client, and typically consisted of thoughts about the client or the felt presence of the client. The IRs generally yielded positive effects, typically both personally and professionally, and were typically discussed with supervisors/consultants. Implications for research, training, and practice are presented.     

Therapist Focus on Parent Involvement in Community-Based Youth Psychotherapy

Parent involvement in the treatment of childhood disruptive behavior problems is a critical component of effective care. Yet little is known about the amount of time therapists are involving parents in treatment and factors that predict therapists' efforts to involve parents in routine care. The purpose of this study is to examine therapists' within-session involvement of parents in community-based outpatient mental health treatment. The data are from a larger longitudinal observational study of psychotherapy for children ages 4-13 with disruptive behavior problems and include videotaped psychotherapy sessions coded for the therapeutic strategies delivered as well as measures of child, parent/family, and therapist characteristics at baseline. Parent involvement is defined as the proportion of time in the session that therapists direct treatment strategies towards parents. Results indicated that therapists directed treatment strategies towards parents an average of 44% of the time within a session. Multilevel modeling was used to examine client-level (child, parent, and family functioning) and provider-level (therapist experience and background) predictors of parent involvement. Therapists involved parents more when the child had higher levels of behavior problems, when the parent reported higher levels of internalized caregiver strain, and when the therapist was more experienced. The results highlight potential areas to target in efforts to increase parent involvement, including training less experienced therapists to increase their focus on directing strategies towards parents.     

SIDE EFFECTS OF THERAPEUTIC PUNISHMENT ON ACADEMIC PERFORMANCE AND EYE CONTACT

The effects of therapeutic punishment delivered following inappropriate behavior on the academic responding and eye-to-face contact of 2 persons with developmental handicaps was examined using a counterbalanced alternating treatment design. Each subject was sequentially taught by two therapists each day. While one of the therapists taught the subject, the second therapist stood in close proximity directly behind the subject. During baseline, neither therapist delivered punishment following inappropriate behavior. During the treatment condition, one of the therapists delivered all punishment regardless of whether she was teaching or standing behind the subject. The therapist who delivered all punishment for 1 subject did not deliver any punishment for the other subject. During the last condition, the therapist delivering all punishment was reversed for 1 of the subjects. The results indicated that the task being taught was mastered by each subject only when the therapist delivering punishment was teaching. Data collected also indicated that each subject made more eye-to-face contact when the therapist delivering all punishment was teaching. Although neither therapist had to deliver punishers often, punishment had to be administered less often when the therapist teaching the subject was also the therapist delivering punishment.     

Women’s preference of therapist based on sex of therapist and presenting problem: An analog study

An analog study was conducted to examine differences in women’s preference for and anticipated comfort self-disclosing to hypothetical therapists of different sexes based on the type of hypothetical presenting problem. The impact of general level of self-disclosure was also examined. Participants included female college students (n?=?187). Anticipated comfort self-disclosing to male or female therapist was rated by subjects when presented with therapists of each sex with the same qualifications. Women preferred and reported higher levels of anticipated comfort self-disclosing to a female therapist. The type of hypothetical presenting problem and general level of self-disclosure also impacted anticipated comfort self-disclosing. There was an interaction between general level self-disclosure and the sex of therapist on anticipated comfort self-disclosing. General level of self-disclosure only impacted anticipated comfort self-disclosing when the therapist was male. This information is relevant for therapists or organizations that provide psychosocial services to women. Organizations may want to inquire about a client’s preferences about sex of therapist beforehand and, if possible, cater to the client’s preference.