Family therapy and the politics of evidence

This article situates family therapy in the politics of evidence-based practice. While there is a wealth of outcome research showing that family therapy works, it remains on the margin of mainstream therapy and mental health practice. Until recently it has been difficult to satisfy 'gold standards' of randomized control research which require manualization and controlled replication by independent investigators. This is because systemic family therapy is language-based, client-directed and focused on relational process rather than step-by-step operational techniques.
As a consequence family therapy is an empirically supported treatment unable to join the evidence-based club. The politics here concerns what is 'evidence', who defines it and the limitations of a scientist-practitioner model. Therapy is art and science and its research needs to be grounded in real-life clinical practice. Common factors such as personal hope and resourcefulness and the therapeutic relationship contribute more to change than technique or model.
While arguing for a wider definition of science and evidence it is politic to seek evidence-based status for family therapy. Family therapy is a best practice approach for all therapists where systemic wisdom helps to decide what to do with whom when . A systemic-practitioner model is informed by quantitative and qualitative research and holds modern and postmodern perspectives in tension, a stance I call paramodern . Family therapy is both scientific and systemic; it is a science of context, narrative and relationship.     

美国临床心理学培养模式的演进及展望

受到社会、组织及自身发展因素的影响, 美国临床心理学在不同时期存在着不同的培养模式。文章选取“科学家－实践者”模式、“实践者－学者”模式、“临床心理科学家”模式、“当下的临床科学家”模式及“循证实践者”模式等五种最具代表性的经典模式, 介绍了1949年以来美国临床心理学培养模式的特点及发展规律。认为“循证实践者”模式修正了前面四种培养模式的个体主义倾向, 将单个的“科学家－实践者”, 分化成“科学家”与“实践者”两个集团, 强调实践者遵循科学家提供的最佳证据, 考虑病人的特征、文化与价值观, 在管理者协调下开展实践。这种模式代表着当代临床心理学培养模式的发展方向。     

Ten Criteria to Qualify As a Scientist-Practitioner in Clinical Psychology: An Immodest Proposal for Objective Standards

The term ‘scientist-practitioner’ has never been defined in clear or objective terminology. Detailed criteria may help to guide new generations of clinical psychologists to live by the ideals of the Boulder model. Ten criteria are proposed for evaluating the scientist-practitioner in clinical psychology across three domains: scholarship, clinical practice, and the integration of science and practice in psychology. The scientist-practitioner remains active in scholarly works, making regular contributions to the field. These contributions are visible at a national level of impact, and they extend beyond teaching. The scientist-practitioner remains active in the clinical practice of psychology, conducting face-to-face work with clients on regular basis, even if it involves a rather modest time commitment. The clinical services reflect standard clinical practices and extend beyond the supervision of others. The scientist-practitioner strives to integrate the science and practice of psychology. This integration centers around evidence-based practice, and can be seen when scholarship examines issues relevant to mental illness and its treatment.     

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.     

Scientist versus Practitioner–An abridged meta-analysis of the changing role of psychologists

This study investigated factors of conflicting expectations and roles of the current psychology practitioners, as well as how these factors were associated with the founding principles of the scientist-practitioner model. Data were gathered from ten published journal articles and then interpreted using an abridged meta-analysis methodology. Results revealed: (a) the scientist-practitioner model needs to adapt to survive, preferably with the aim of becoming more versatile; (b) The majority of graduate level clinical psychology training programs are based on a flawed version of the scientist-practitioner model, which renders the training inadequate and ineffective; (c) The identity of clinical psychology should remain firmly grounded in mental health care, and so not encroach on the territory of any other psychological divisions. Implications of these findings and suggestions for psychology practitioners are also discussed.     

The Scientist-Practitioner Model: Now More Than Ever

The scientist-practitioner model has been fundamental to the field of professional psychology for over 50 years. Although other training models have been offered in an attempt to improve training or meet other needs, we view many of the changes suggested by these models as consistent with the original intent of scientist-practitioner training. We argue that the reciprocal effects of science and practice within this model, if appropriately integrated, remain an excellent fit for integrating science and practice and enhancing the quality of both the practice and science of psychology. We address some of the problems with how the model has been implemented and offer recommendations for ways to enhance science and practice integration. Finally, we describe some of the mechanisms we have used to put these principles into practice in our counseling psychology training program.     

Integrating scientist and practitioner training in counseling psychology: Practicum is the Key

Recently, revitalized interest has been shown in the scientist-practitioner approach to training counseling and other applied psychologists. The counseling practicum is proposed as potentially the most influential and effective forum in which students can learn to integrate science and practice within the counseling psychology training sequence. A series of recommendations are presented for the more effective integratin of training in science and practice through students' clinical preparation experiences in general and the counseling practicum in particular.     

Thematic review of family therapy journals in 2004

In this paper the principal English-language family therapy journals published in 2004 are reviewed under the following headings: evidence-based practice, common factors in effective therapy, innovations in family therapy, innovations in couples therapy, training, gender, diversity, international developments, terrorism, and historical transitions.     

Structural Family Therapy and Autism Spectrum Disorder: Bridging the Disciplinary Divide

ABSTRACT

Applied Behavior Analysis (ABA) is an evidence-based practice approach for the treatment of individuals with autism. The systemic effects of autism suggest that family therapy would considerably enhance the treatment of individuals with autism. Marriage and family therapy (MFT) training does not routinely include exposure to autism beyond the associated diagnostic criteria. Structural Family Therapy (SFT) is a systemic model that is familiar to those trained in family therapy and appropriate for the needs of families affected by autism. Therefore, the authors have used SFT as a foundation for supervising MFT trainees working in an autism treatment setting.     

Family Therapy in the Heart of Europe

The article introduces the situation of family therapy and systemic practice in the Czech Republic. It gives an overview of family therapy history and development in the country. Both historical and political background including major transformation events in the last couple of decades are presented so as to explain the contextual frame for major challenges, which Czech family and systemic therapists have been facing in this part of Europe. The current situation of family therapy in the Czech Republic is described in detail with regard to leading figures, major schools, training issues, international exchange and clinical practice in various settings.     

Training staff in multiple family therapy in a children's psychiatric hospital: from theory to practice

This article describes a systematized method for training clinical staff from a variety of mental health professions while implementing supportive, process‐oriented multiple family therapy (MFT) in a children's psychiatric hospital. The model uses a step‐by‐step approach based upon learning objectives specific to the theory and practice of MFT for each stage of the process. External consultants skilled and experienced in MFT supported tuition in the initial stages. The method employs seminars with theoretical and experiential components, highlighting the major conceptual features of group, family therapy and MFT. Advanced stages of the training model include experiential learning in small groups and ongoing peer group supervision with live families. The systematic procedure has relevance for ongoing supervision, research and best standards of clinical practice in the hospital.     

Family-based treatment for adolescent substance abuse: controlled trials and new horizons in services research

This article provides an overview of controlled trials research on treatment processes and outcomes in family-based approaches for adolescent substance abuse. Outcome research on engagement and retention in therapy, clinical impacts in multiple domains of adolescent and family functioning, and durability and moderators of treatment effects is reviewed. Treatment process research on therapeutic alliance, treatment fidelity and core family therapy techniques, and change in family processes is described. Several important research issues are presented for the next generation of family-based treatment studies focusing on delivery of evidence-based treatments in routine practice settings.     

Graduate psychology students' perceptions of the scientist-practitioner model of training

Since its inception over forty years ago, there has been considerable controversy regarding the viability of the scientist-practitioner model for training professional psychologists. The present study utilized a combination of qualitative and quantitative research methods to assess graduate psychology students' (n=24) perceptions of this training model. Counselling, clinical, and school psychology students participated in semi-structured interviews and were administered the Vocational Preference Inventory, Form B (Holland, 1977) and the Scientist-Practitioner Inventory (Leong & Zachar, 1991). Data were analyzed using a combination of grounded theory (Glaser & Strauss, 1967) and additional qualitative data analytic approaches (Miles & Huberman, 1984). A number of patterns were observed between students' perceptions and feelings about the scientist-practitioner model and their definition of science, career interests, and shaping experiences. Implications for the future training of professional psychologists are discussed.     

Values in Family Therapy Practice and Research: An Invitation for Reflection

Values have been shown to be a pervasive part of both marriage and family therapy (MFT) clinical practice and research. Yet, many therapists and researchers remain unclear about how values affect their work. This article examines the influence of Western philosophical assumptions and therapy traditions in light of current understandings of values in therapy. The influence of values in MFT research processes is similarly examined. Implications for how family therapy professionals can be more reflective and sophisticated in their understanding of values in clinical practice and scientific inquiry are discussed. Suggestions for addressing values in MFT training also are given.     

The (even) bolder model. The clinical psychologist as metaphysician-scientist-practitioner

Is the clinical psychologist best characterized as a scientist-practitioner? Or does the practice of science and psychotherapy involve metaphysics to such an extent that the clinical psychologist ought to be considered a metaphysician-scientist-practitioner? To answer these questions, the roles, if any, of metaphysics in science and psychotherapy are examined. This article investigates this question by examining the views of the logical positivists, Karl Popper and Imre Lakatos, and concludes that the practice of science and psychotherapy involves metaphysics in (a) problem choice, (b) research and therapy design, (c) observation statements, (d) resolving the Duhemian problem, and (e) modifying hypotheses to encompass anomalous results.     

Science and behavior therapy: A survey of research in the 1970s

A representative sample of a decade of contributors to the journals Behavior Therapy, Behaviour Research and Therapy, Journal of Applied Behavior Analysis and the Journal of Behavior Therapy and Experimental Psychiatry was asked to report on their motivations for conducting studies that had been published in that journal. Results indicated that the primary motivation of behavioral researchers was to build on prior research through gathering and analysis of data to illuminate applied-clinical issues and validate treatment procedures. Few researchers reported consultation arrangements or efforts to replicate as their motivation for research. Most respondents described the training model in which they had received their doctoral education as oriented toward a scientist-practitioner approach rather than one that focused primarily on research, therapy or assessment training. Most respondents noted that their philosophy of behavior therapy at the time of the study in question to be applied behavior analysis or social-learning theory with far less being affiliated with a neobehavioristic mediational S-R model or cognitive behavior modification. These results are discussed within the context of the relevance of clinical research in behavior therapy and professional psychology.     

Curriculum and training reform in clinical psychology: Improving the integration of science and practice

Current graduate curricula do not fully grapple with and take advantage of the dialectical interplay of science and practice that is at the core of the scientist—practitioner (Boulder) model. This article addresses factors that interfere with the realization of the Boulder model and offers suggestions for curriculum reform. It emphasizes the importance of both science and practice, as well as the merit of both nomothetic and idiographic approaches to clinical training. The article discusses how academic politics often interfere with the incorporation of empirically supported treatments or assessment methods into training programs. Even when evidence-based approaches are a part of the curriculum, the challenges continue. Because empirically supported treatments are almost always associated with treatment manuals that rely on categorically defined diagnostic categories, they may inadvertently discourage idiographic functional analyses and the appreciation of underlying change principles. In addition, in light of the fact that many, if not most, students eventually pursue applied careers and because science-based interventions and assessment methods are currently underused by clinicians in the field, it is argued that clinical training should receive more recognition in scientist—practitioner programs. Programs should be mindful of the need to prepare a certain subset of interested students for scientifically based careers in applied settings. This article also highlights the importance of educating and training students in communicating and disseminating science-based clinical psychology to nonacademic psychologists and health professionals from other disciplines.     

The Theory-Practice Gap in Cognitive-Behavior Therapy

This special series is devoted to understanding the theory-practice gap in cognitive-behavior therapy (CBT). Although CBT enjoys considerable empirical support, and is widely recognized as an efficacious approach to a diversity of psychiatric disorders and includes many different forms of treatment, it is unclear whether clinicians are familiar with the underlying theories of the treatments they are practicing. Moreover, it is unclear to what degree an understanding of the theory is necessary for effective practice. Gaining clarity on the role of understanding underlying theory and identifying potential disparities between theory and practice may have implications for the way graduate training programs are structured and current professionals approach continuing education. A brief exploration of these implications will be offered by introducing issues related to the scientist-practitioner model and dissemination of efficacious treatments, in addition to an outline of potential advantages and disadvantages of knowing underlying theory. This special series will then feature several major approaches to treatment wherein the role of theory and practice are discussed.     

Comments on "Distinguishing science from pseudoscience in school psychology:" Evidence-based interventions for grandiose bragging

The purpose of this article is to provide some perspectives on Lilienfeld, Ammirati, and David's (2012) paper on distinguishing science from pseudoscience in school psychology. In many respects their work represents an intervention for "grandiose bragging," a problem that has occasionally occurred when various non-evidence-based or discredited interventions receive sensationalized positive endorsement for adoption in school psychology practice. In this paper, the implications of the Lilienfeld et al. work are discussed within the context of the scientist-practitioner gap, scientific thinking and evaluation of scientific thinking, and negative results research. The authors have advanced our thinking on evidence-based practices in school psychology and education.     

Thinking,Doing, and the Ethics of Family Therapy

In this article, we examine how family therapists develop their capacity to make ethical decisions in clinical practice. We present an approach to clinical ethics that builds upon, and integrates the central features of, professional training and development in family therapy itself. We also explore the similarities and differences between the theoretical, top-down approach of bioethics, with its emphasis on “principled decision making,” and the clinical, pragmatic, bottom-up approach discussed here.