Second-Order Change in Marriage and Family Therapy: A Web-Based Modified Delphi Study

Second-order change is a central concept in Marriage and Family Therapy, but still remains poorly operationalized. We conducted a web-based modified Delphi study with 31 established faculty members currently teaching in COAMFTE-accredited Master's and Doctoral programs in the United States and in Canada to identify consensus regarding second-order change concepts, clinical operationalization, evaluation, and teaching principles. Numerous exemplars of first and second-order change were generated, but consensus on most items was low. Consensus was highest for pedagogy and low regarding concepts and clinical examples of first-order change and evaluation of second-order change. Results suggest clearer definitions and better measurement of systemic change are needed.     

Family and Couples Therapy in a Time of War

SUMMARY

In this article the issue of professional responsibility of couples and family therapists is raised with regard to the war in the Persian Gulf. Implications are discussed for families and couples coping with the stress of war and its aftermath.     

It is All Personal: Further Thoughts on Therapeutic Action: Commentary on Paper by Noelle Burton

This paper evolved from an earlier panel presentation on conceptual tributaries to relational thinking at the 2015 International Association for Relational Psychoanalysis and Psychotherapy Conference in Toronto. Representing the place of Object Relations theory in the DNA from which Relational Psychoanalysis emerged, I emphasized—and provide here an abbreviated review of—the contributions of Fairbairn, Klein, and Winnicott. Then, as now, believing in the communicative power of clinical examples, I offer an extended clinical narrative in which the medium is the message and clinical phenomena such as multiple self-states, enactments, negotiation, play, and the residue of internal object relations (in both patient and analyst) are brought to life. Also, as the Toronto Plenary overview paper by Jody Davies has developed into its current substantial elaboration of distinctly relational issues (multiple self-states, co-creation, and the interplay of process and insight) and serves as the capstone paper for this published version of our panel, I respond to Jody’s conceptual contributions and her perspective on Relational thinking.     

Learning and Living Systemic: Exploring the Personal Effects of Family Therapy Training

Despite growing recognition that systemic family therapists need to be adept at personal reflection and managing the therapeutic relationship, little research has explored the effects of training beyond the development of skills. This article provides a report on a qualitative study focussed on the personal effects of family therapy training, with particular reference to the aspects of training that foster personal reflection and growth. Twenty three trainees from three training institutions were interviewed, utilizing the practices of grounded theory. Trainees reported a deepening relational awareness, which applied to both personal and professional domains and included shifts in perspectives on relationships with loved ones. Five aspects of training were identified as responsible: (1) personally challenging experiences with clients; (2) supervisors who live the paradigm; (3) the demystification of theory; (4) a safe supervisory space; and (5) the development of trusting peer relationships. Interns also described, in turn, how their personal development affected their clinical work, particularly in the development of compassion and empathy. This study serves to highlight training practices that support reflective practice in systemic family therapy.     

Conversational Construction of Meaning in Family Therapy: Some Evolving Thoughts on Kelly's Sociality Corollary

Combining the ideas of constructivists in the fields of cybernetics, physics, biology, philosophy, social psychology, and family therapy with the ideas of Kelly, we offer some thoughts on the importance of the interactional construction of meaning. The implications of a dialogical perspective are explored by addressing three key issues often encountered in the initial stages of working with families: (1) identifying the relevant system for treatment, (2) codefining the problem, and (3) establishing the therapist's position. A conversational approach to constructing meaning, as outlined in this paper, assumes that the therapist must take full responsibility for his or her participation in the cocreation of social reality.     

The Management of Personal and Professional Boundaries in Marriage and Family Therapy Training Programs

The authors review the function of boundaries within teaching and supervisory relationships and identify patterns that create vulnerability to boundary infringement. Boundary violations are conceptualized as a process that that is more likely to develop when teachers and supervisors are isolated and under stress. Suggestions are made for a personal check up that focus on self-care, student care, and care of the professional group.     

Third‐Order Thinking in Family Therapy: Addressing Social Justice Across Family Therapy Practice

We contend that the field of family therapy is undergoing a notable shift from second‐ to third‐order thinking. We offer theoretical support and examples to demonstrate how third‐order thinking provides a framework for integrating heightened sociocultural attunement into family therapy practice. We discuss the importance of third‐order thinking relative to being prepared to invite families into third‐order change. Finally, we offer a case example to show specific guidelines for third‐order practice.     

Bridging Conversations: Discussing the Intra‐professional Relationship between Medical Family Therapy and Family Therapy

This article examines the conceptual and practice relationship between medical family therapy (MedFT) and its parent field, family therapy, with MedFT viewed as the extension of relational sense‐making and understanding into a specific venue; that of medicine. The extension of this relational meaning system into medicine is typified by the ability of the therapist to negotiate and connect three main areas of conceptual difference that often account for conflictual relationships between mental and biomedical healthcare providers: (i) patient and provider conceptualizations of issues and goals, (ii) linear and circular understanding of issues and goals and (iii) consultative and expert positions on issues and goals. Two case examples are offered to describe how these three areas of tension are reconciled in practice.     

Brief Therapy in Adult Psychiatry – Further Outcomes

A report of a one-year follow-up of thirty-six referrals treated with solution-focused brief therapy by a supervised team in a mental health setting is described. A good outcome was reported for twenty-three cases (64%). These results are comparable with our previous work and with one other statistically validated outcome study on solution-focused therapy.     

Self‐Image Motives: Further Thoughts and Reflections

The commentaries provided by Kruger, Galek, and Burrus and Sedikides, Gregg, Cisek, and Hart spark some speculations concerning future questions to study. The belief harmonization approach may provide an explanation, for example, for why people tend to be more dissatisfied with complex rather than simple decisions. In addition, if individual differences in self‐esteem and related constructs matter, then the impact of self‐image motives on consumer behavior, from a historical perspective, may be increasing.     

Comments on Research in Family Therapy

This comment is submitted with the intent of stimulating some exchange between researchers. Although I chose the Woodward et al. study as a vehicle for my statement, I might easily have chosen examples outside the family therapy area.     

Reflections on Family Therapy in Australia

Family therapy in Australia has been influenced by ideas mostly from North America and Europe. However Australian family therapists have also made their own significant contributions to theory and practice. The vastness of the continent combined with a relatively small population has presented challenges with respect to the formation of a national association and for many years, the Australian Journal of Family Therapy (later the Australian and New Zealand Journal of Family Therapy Board acted as de facto national voice for the discipline. The Australian Association of Family Therapy was formed as recently as 2011. It has a total of over 1,000 members and is the sole organisation representing family therapy and family therapists in Australia. Clinical membership is achieved via successful completion of a 2-year sequence of study in family therapy followed by 50 hours of supervision (or its equivalent). Family Therapy training is mostly delivered in the four most populated states in Australia at both University level and through private organisations registered to provide training at government approved levels. La Trobe University (through the Bouverie Centre), Swinburne University (through the Williams Road Family Therapy Centre) and the University of New South Wales currently provide training leading to specialist qualification in family therapy. A number of other private institutions also provide recognised family therapy training. To date, family therapists and couple therapists in Australia have not in the main shared common platforms such as conferences, training and professional journals. Narrative therapy has also remained somewhat detached from “mainstream” family therapy. Family therapy qualifications are often valued by prospective employers even when duty statements are focused on the more traditional skills of professionals such as psychologists or social workers. Researching family therapy outcomes remains challenging. But although there is increasing practiced-based evidence of the efficacy of family therapy, Australian family therapists as a group are yet to concentrate their efforts on convincing funding bodies of its usefulness. At the same time, via the teaching and promotion of family sensitive practices, systemic ideas are being increasingly incorporated within areas of mental health, disability, alcohol and drug dependency, and within a range of health and welfare areas that impact not just on the individuals but on those close to them.