Difficulty in implementing a family intervention for bipolar disorder: the predictive role of patient and family attributes

Family affect was examined as a predictor of difficulty implementing a 9-month, manual-based, psychoeducational family therapy for recently manic bipolar patients. Prior to therapy, family members were administered measures to assess both their expressed emotion and affective behavior during a family interaction task. Following family treatment, both therapists and independent observers rated the overall difficulty of treating the family, and therapists also rated each participant's problem behaviors during treatment, in the areas of affect, communication, and resistance. Therapists regarded affective problems among relatives and resistance among patients as central in determining the overall difficulty of treating the family. Relatives' critical behavior toward patients during the pretreatment interaction task predicted both independent observers' ratings of overall treatment difficulty and therapists' perceptions of relatives' affective problems during treatment. Moreover, patients' residual symptoms predicted independent observers' ratings of overall difficulty and therapists' perceptions of patients' resistance to the family intervention. Results suggest that difficulties in conducting a manual-based family intervention can be predicted from systematic, pretreatment family and clinical assessment.     

A developmentally keyed scheme for the placement of gay men into psychotherapy groups

Patients can meet their needs for intimacy and individuation within the context of long-term psychotherapy groups. This is especially true for gay male patients as they work toward the development of a positive gay identity. Coming out is a social phenomenon, which is why groups are especially suited to the tasks involved. Historically, mixed groups of gay and nongay men and women have not been a safe or neutral treatment atmosphere for gay men due to therapists' prejudicial assumptions and a lack of understanding of gay male development. A developmental scheme will be presented which is keyed to the particular needs of gay men depending on their developmental stage of functioning. This scheme should serve as a more rational and appropriate guide for the diagnosis, treatment planning, and assigning of gay men to long-term psychotherapy groups.     

'No-show': therapist racial/ethnic disparities in client unilateral termination

In the present study, the authors examined the source of racial/ethnic minority (REM) disparities in unilateral termination (i.e., the client ending therapy without informing the therapist)--a form of dropout that is associated with poor alliance and outcome. First, the authors tested whether some therapists were more likely to have clients who reported unilaterally terminating as compared with other therapists. Next, the authors examined 2 competing hypotheses regarding the therapists role in termination disparities: (a) that racial/ethnic disparities in unilateral termination are similar across therapists and thus due to other components of the treatment process or (b) that racial/ethnic disparities in unilateral termination are specific to therapists, where some therapists are more likely, on average, to have higher rates of unilateral termination with REM clients as compared with White clients. The sample included 155 REM clients and 177 White clients who were treated by 44 therapists at a university counseling center. The results showed that therapists accounted for a significant proportion of the variation in clients' unilateral termination, and REM clients were more likely to report they unilaterally terminated from therapy as compared with White clients. Furthermore, racial/ethnic disparities in clients' report of unilateral termination varied across therapists' caseloads. These results suggest that therapists have a central role in their clients' unilateral termination and have implications for understanding racial/ethnic mental health disparities.     

The Debate: A Strategic Technique

This paper describes the work of a strategic team that came out from behind the one-way mirror. A debate among the team is enacted before the family as a strategy for change. The case of a family that refused to provide information illustrates an application of this method. The debate among the therapists represents a dilemma that is a strategically constructed isomorph of the family situation. From this position, therapists have the option of changing levels between themselves and the family, asking the family to help solve the therapists' dilemma so that they in turn can be free to help the family. The combination of the debate and the change of levels between the therapists and the family creates a therapeutic neutrality for the family. From their meta position, they observe the therapists' struggle to solve the family's problem, which is re-presented as a problem among the therapists. This perspective offers the family the choice of more adaptive solutions to their own dilemma.     

Why families of children with biological deficits require a systems approach.

A number of assumptions related to the systemic therapists' view of family functioning in the case of biological deficit in the child are presented and challenged. The families' behavior, it is argued, may not be primarily responsible for the difficulties of their biologically impaired offspring. Severity of handicap need not be directly linked to stress in these families, nor is avoiding an individual diagnosis helpful to them. To further clarify the relevant issues, the family's "reactions" to a dysfunctional member, along with the professionals' previously unhelpful approaches to dealing with the impairment of these children, are presented. Finally, the therapeutic implications of the position presented in this article are drawn, and specific recommendations for working with these families are offered.     

The Impact of the Family Environment on the Ethnic Identity Development of Multiethnic College Students

In this qualitative study of 5 multiethnic college students, the findings indicate that family environment played a significant role in the participants' ability to develop secure ethnic identities. The participants who described their family members as supportive of their multiple ethnic backgrounds also felt confident about their ethnic identity, whereas the participants who described their family members as unsupportive of their multiple ethnic backgrounds maintained that they often felt insecure about their ethnic identity.     

My Family Made Me Do It: The Influence of Family Therapists'' Families of Origin on Their Occupational Choice

This study is an empirical test and exploration of the folklore about family life correlates of family therapists' occupational choice. The folklore is translated into systems concepts, including role complementarity and the mutually determining effect of process and roles. Fifty-nine family therapists, 49 siblings of the therapists, and 51 undifferentiated, non-helping professionals were compared on FACES (29), The Complementary Role Questionnaire, and on demographic data. Inconsistencies in the results led to a critique of the clinical faithfulness of current systems measures. Family therapists did not differ on FACES, but did differ in aspects of roles from their siblings and from the control professionals.     

The hidden meanings of metaphors in family therapy

This study investigates how two therapists' beliefs and practices influence the therapeutic process when they organize social interaction according to a metaphor of a royal family. The therapeutic process is described through the case of a boy called Pelle. He comes to therapy together with his family. It is shown how the therapists collaborate in the process of implementing the worldview of the predefined normative standard for family life. In the short term the therapists' use of the metaphor can be seen as an intervention to accomplish immediate change in a non-threatening way. In the long term the cost of using the metaphor was that the mother got a confirmation about herself as a less powerful parent and the child got an image of being a failure. This study points out that metaphors as therapeutic tools have to be analyzed critically before they are used or more specifically the therapists have to examine what kind of values and meanings are hidden in the metaphor and who will gain and loose if it is used as an intervention.     

The Slovak-American “Swaddling Ethos”: Homeostat for Family Dynamics and Cultural Continuity

This paper explores the systemic relationships among cultural ethos, family dynamics, personality configuration, and child-rearing patterns among multi-generation Slovak-Americans. The “swaddling ethos” is posited to serve as a homeostat whose regulatory function can be discerned through the analysis of family structure and process, in particular through the explication of values, affective patterns, roles, boundaries, and structural units within the family. The core of the ethos is a dependency-security complex that attaches the individual to an extended family network of obligation, indebtedness, and reciprocity (ethnic, Slovak); induces rebellion against such attachment (mainstream, American); and undermines efforts toward separation-individuation, resulting in the perpetuation of an ethnic tradition.     

Twenty Years on – Water under the Bridge

My paper in the first issue of the Journal of Family Therapy outlined some ideas which have continued to form the basis of my practice of family therapy ever since. Using the psychoanalytic concept of 'counter-transference' I suggested that opening themselves to the emotional interaction of the family will usually lead to a reproduction of the essential basic family conflict within the therapists' own psyches. In this way the therapist takes on the role assumed by many 'family scapegoats', expressing some emotion 'for' the family which other members dare not articulate or even entertain.     

Ethnic Identity,Family Cohesion,and Symptoms of Post-traumatic Stress Disorder in Maltreated Youth

Post-traumatic stress disorder (PTSD) is prevalent among maltreated youth, but little empirical work exists regarding the role of ethnic identity and family cohesion as influential factors among different ethnic groups. This study included an ethnically diverse sample of adolescents affiliated with a state-administered residential facility for maltreated youth. Variables included ethnic identity and family cohesion, as well as symptoms of PTSD, depression, dissociation, and post-traumatic cognitions. The most prominent finding was that low family cohesion predicted greater PTSD symptoms, depression, dissociation, and post-traumatic cognitions. This finding was especially pronounced for multiracial youth. Results are discussed within the context of developmental pathways regarding ethnic identity development in multiracial youth.     

Motivation to Control Prejudice as a Mediator of Identity and Affirmative Action Attitudes1

Affirmative action is a divisive issue in society today. Attitudes toward affirmative action vary both between and within ethnic and racial groups, with Whites exhibiting the majority of negative attitudes. Researchers have suggested a variety of psychological explanations for differences in attitudes toward affirmative action (e.g., racism, self‐interest, fairness). The current study investigates whether motivation to control prejudice acts as a mediator of ethnic/racial identity and Whites’ attitudes toward affirmative action. Support was found for the mediating role of motivation to control prejudice for several aspects of ethnic and racial identity and affirmative action attitudes. Limitations of the study are discussed, as are topics for future research.     

Culturally sensitive therapy? Examining the practice of cross‐cultural family therapy

This article is drawn from a research project that examines cross‐cultural family therapy sessions in order to consider what constitutes culturally sensitive practice. A discourse analytic approach was adopted in the analysis of three sessions from two families where the family and the therapists originated from different ethnic backgrounds. This article is based around part of the research findings connected to one of the families, and focuses upon the ways in which ‘culture’ is talked about in therapy (the term ‘culture’ will be referred to in inverted commas in order to acknowledge its complexity as is emphasized in this article). This allows for an examination of the cultural assumptions that we hold as therapists, which are enacted in therapy with effects on all participants and upon the course of the therapy. The value of qualitative research methods in examining the cultural assumptions we bring to therapy is highlighted as one way of improving culturally sensitive therapeutic practice, especially with regard to therapist reflexivity.     

ACCULTURATION AND EATING DISORDERS IN A MEXICAN AMERICAN COMMUNITY SAMPLE

Our purpose was to investigate acculturation and eating disorders by examining the role of ethnic identity and by utilizing a bidimensional perspective toward two cultures. We predicted that orientation toward European American culture and lower ethnic identity would be positively associated with eating disorders. Participants were 188 Mexican American women recruited from the community (79 with eating disorders and 109 control women). The Structured Clinical Interview for DSM-IV-TR and Eating Disorder Examination were used to establish diagnoses. The Acculturation Rating Scale for Mexican Americans–II and the Multigroup Ethnic Identity Measure assessed Anglo orientation, Mexican orientation, and ethnic identity. Orientation toward Anglo American culture was significantly associated with eating disorders, whereas orientation toward Mexican culture and strength of ethnic identity were not associated with eating disorder status. Findings point to the role of Anglo cultural orientation in the development of eating disorders and underscore the need for future research to utilize bidimensional models.     

The Role of Creativity in Marriage and Family Therapy Practice: A National Online Study

The purpose of this study, using an online methodology, was to investigate therapists' perceptions of the role of creativity in couples' and family therapy. Along with completing a quantitative measure assessing creativity in their work, participants responded to four open-ended questions which addressed the meaning of creativity, characteristics of a creative family therapist, some creative interventions they have used with couples and families, and barriers to their own creativity as a family therapist. A total of 142 marriage and family therapists in 36 states in the United States participated. The findings shed light on the unique importance of creativity in couples and family treatment.     

回族儿童族群偏爱态度的形成与发展

以回族儿童为被试,从发展心理学的视角,两个研究分别考察了回族儿童族群偏爱态度的形成及其发展特点。研究1借鉴经典的学前儿童种族族态度测验法,发现儿童在4岁时开始具有民族类别意识,并产生内群（回族）偏爱态度;研究2运用内隐联想测验范式以及自我报告法,发现无论内隐态度还是外显态度,儿童均表现出强劲的内群（外群体为汉族）偏爱态度,并且内隐偏爱态度随年龄增长而增强,外显态度随年龄增长趋于稳定。最后讨论了本研究与国外研究结果差异的原因,并展望了未来研究的方向。     

Spirituality as a Dimension of Family Therapists' Clinical Training

From its psychoanalytic beginnings, therapy training has emphasized the crucial role the self of the therapist plays in the effectiveness of therapy. Attention initially focused on therapists' personal history and vulnerabilities and later included an exploration of their relationship style. Less emphasis has been placed on analyzing therapists' belief and meaning systems which inescapably influence their clinical conceptualizations, attitudes, and behaviors. This article defines spirituality as attributions of a personal nature which give meaning to life events, help transcend difficult experiences, maintain hopefulness, and lead to behaviors which honor connectedness and proposes a rationale for including the spiritual dimension in therapy and therapy training and steps graduate training programs and supervisors may take to raise therapists' spiritual understandings.     

Miami in the 1990s: “City of the future” or “City on the edge”?

No city in the United States, and few in the world, have been as profoundly affected by immigration in as short a period of time as Miami, Florida. The result is a complex pattern of ethnoracial politics among the city’s Hispanics, Blacks and Anglos–a pattern that defies conventional models of ethnic relations and immigrant adaptation. This article focuses on the latinization of Miami and the implications for ethnoracial relations of an immigrant group that achieves rapid economic and political ascendancy while challenging conventional assumptions about ethnic assimilation. The article also examines the role of local government structures in both shapping or responding to the dynamics of ethnoracial politics.     

The Effect of Therapist–Client Racial Similarity on Client Satisfaction and Therapist Evaluation of Treatment

Client satisfaction with therapy services and therapists' perspectives of treatment evaluation were examined in relation to therapist and client racial similarity. Secondary data from a university marriage and family therapy clinic located in the southeast was used to pair therapists and clients on racial similarity or difference. Statistical analyses revealed no major differences in clients' perceptions of satisfaction based on similarity to therapists' race. Therapists indicated some differences in their perceptions of the success of services provided to clients based on similarity to client's race. Implications for researchers, clinicians, and educators are included.