Dropping Out of Couple Therapy

Abstract

Current literature on dropouts in marriage and family therapy includes few studies that focus exclusively on couple therapy and only a limited number of qualitative studies. Clients' perceptions of premature termination are seldom considered. This qualitative case study describes, from both the clients' and the therapist's perspectives, one couple's experience of dropping out of couple therapy after three, sessions. Findings from this case study are compared with existing literature and a fourfold typology of dropouts is proposed. We offer recommendations for future research of dropouts in couple therapy.     

The Results of Family Therapy: A Critical Review of the Literature

A search was conducted in the family therapy literature for studied which reported on the outcome of family therapy. It was difficult to find any consensus on a definition of family therapy. Therefore an arbitrary definition, involving the predominant use of joint and family interviews, was stipulated. A total of eighteen studies met minimal standards for inclusion and were summarized and discussed in this paper. Only two of these studies could be considered adequate in their research design; the remainder of the studies were (with one borderline exception) considered inadequate. The clinical evaluations of family therapy were summarized and possible methods and goals for future research into the outcome of family therapy are discussed.     

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.     

Cross-Cultural Supervision in Marriage and Family Therapy

The purpose of this study was to gain an understanding of the various cultural factors that influence the supervisor-trainee relationship when at least one of these individuals is a member of an ethnic minority group in the United States. Marriage and Family Therapy supervisors and students were asked to compare and contrast their experiences working with ethnic minority and white persons. Findings indicate that both supervisors and students express great value in cross-cultural supervisory experiences, but report that these opportunities are very limited.     

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.     

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.     

Textbooks in Accredited Marriage and Family Therapy Programs

Although choices of required textbooks are important decisions in developing a course curriculum, faculty in marriage and family therapy training programs have few convenient resources to guide curriculum development. This article presents results of a survey of textbook selections of accredited marriage and family therapy programs within a regional affiliate of AAMFT. The five programs surveyed listed 108 different titles used in their curriculum. Only 12 texts were used by two programs, and only one text was used by more than two programs. This article presents the textbook selections by the six curricular areas of COAMFTE accreditation standards. The wide variety of textbooks used by programs leads us to conclude that no consensus exists about what textbooks best represent the core knowledge of marriage and family therapy. The body of knowledge taught in accredited marriage and family training programs reflects a distinct and autonomous body of knowledge.     

The Lived Experience of Marriage and Family Therapy Doctoral Graduates: A Phenomenological Study

Abstract

This qualitative study was conducted with nine individuals who have successfully completed a Marriage and Family Therapy (MFT) doctoral program. A hermeneutic phenomenological approach was employed to explore the experiences of these MFT doctoral graduates and the contributing factors to their success. The four overarching themes that emerged from the data included: (1) Necessity of and dependence on connections and support systems, (2) Becoming adept at overcoming challenges through limited resources, (3) Ability to translate skills and integrate processes, (4) Gratitude and appreciation for the journey. Implications for this field of study are discussed. Future research and implications are explored.     

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.     

Child Access and Visitation Following Divorce: A Growth Area for Marriage and Family Therapy

Recent federal legislation encourages states to increase noncustodial parents' access and visitation with their children following separation or divorce. The State of Iowa Department of Human Services Bureau of Collections commissioned a pilot study to provide a beginning picture of how parents and professionals experience the child access and visitation process. Two midsized urban centers and a rural community were studied. A total of 14 divorced parents and 16 professionals who work with divorced individuals were interviewed using a 2-hour focus group format. Study findings identified problematic themes regarding child access and visitation, potential solutions, and suggested services to address these problems. The services suggested by the study all fall within the professional expertise of marriage and family therapists. A primary finding of the study was the need for therapy and mediation focused on relational issues.     

Multiple Family Group Therapy: A Review of the Literature

This review focuses upon multiple family group therapy, its origin in the intersection of family and group therapies, its use in a variety of settings, its specific techniques and group development in individual and ongoing meetings, its goals and dominant themes, its parallels in family and group work. Also discussed are evaluation of outcome of this therapy modality and those dynamics thought to contribute to family change. Areas for further investigation are outlined.     

Ethical Issues and At-Risk Behaviors in Marriage and Family Therapy: A Qualitative Study of Awareness

This exploratory study investigated perceptions of and relationship with professional ethics of therapists-in-training. A focus group of marriage and family therapy doctoral students explored self-awareness and at-risk behaviors regarding ethical competence and compliance. A grounded theory analysis of data is presented as a conditional matrix, which offers a theory of development between therapists and their perception of ethics. The Practitioner-Relationship Ethics Model represents findings of interaction between confidence in ethical principles, field experience, use of justification, and at-risk behaviors. Implications and limitations of these findings are presented, as are suggestions for research.     

Career Paths of Eminent Researchers in Marriage and Family Therapy

The mental health field of marriage and family therapy (MFT) needs more MFT researchers and more research to validate and verify the effectiveness and efficacy of MFT for the treatment of various mental health and relational problems. Knowing more about how successful researchers have developed their careers would be useful in both inspiring and guiding young MFT researchers toward success. Three eminent researchers whose careers have focused on MFT (James Alexander, John Gottman, and Howard Liddle) and their publications served as the research sample. Research questions addressing types of research, research samples, research questions, therapy model development, funding, and paths of the research careers were answered using content analysis. Results support guidelines that include having a focused research interest area, adhering to the scientist-practitioner model, obtaining funding, maximizing the utility of research samples, and generating publications.     

Exploring Gender Bias Against Women: Ethics for Marriage and Family Therapy

During the past 15 years, the negative implications of the female gender role, as demonstrated by marital dissatisfaction and mental health problems, have been documented extensively in the social science, psychology, and feminist literatures. In this article, developmental and psychological assumptions about women that are fundamental to current marriage and family therapy practice are explored. The authors call attention to the absence of substantive knowledge about women's development and to the ethical risks associated with reliance on traditional gender role notions in work with female clients. Ethical guidelines for reducing bias in therapy, especially with couples and families, are offered to counselors and therapists for evaluation and refinement of professional gender role sensitivity.     

A Review of Family Therapy in Residential Settings

This article provides an overview of the history of family involvement in residential treatment as well as a synthesis of the research showing family-centered interventions and outcomes for youth in residential settings. There are many methods for engaging families in residential treatment that are discussed in the literature; however, there is a significant gap as the field has not yet identified specific family therapy approaches that demonstrate efficacy in working with youth and their families in this particular setting. A review of the literature over the past 10 years will highlight the emerging family therapy models being utilized in this setting, which include multiple-family group intervention, family-directed structural therapy, and narrative family therapy. The article will also include a discussion of three major, well-established theoretical approaches that have been found to be effective in working with youth with conduct issues and show promise in treating youth and families in the complex setting of residential treatment: brief strategic family therapy, multi systemic therapy, and functional family therapy.     

Distinguishing Between Conceptualizations of Attachment: Clinical Implications in Marriage and Family Therapy

Authors described four distinct conceptualizations of the construct of attachment and identified clinical implications associated with each. Three of the conceptualizations, which are influenced by the work of Bowlby and Ainsworth, seem to have some empirical support; these conceptualizations are compatible with systemic and social constructionist approaches to family therapy. The other conceptualization— Reactive Attachment Disorder (RAD)—contradicts the extensive body of literature associated with the Bowlby/Ainsworth traditions and tends to pathologize children. Therefore, family therapists interested in attachment are encouraged to maintain conceptual clarity in their clinical work and are further encouraged to rely on clinical conceptualizations and interventions that are consistent with the work of Bowlby and Ainsworth.     

Gendered Training: Men and Men's Issues in Marriage and Family Therapy Programs

Few studies examine men's experiences in becoming a therapist. Only a modicum of attention appears to be paid to men's professional training needs in MFT training programs as expressed in the family therapy literature. Five recommendations, based on the author's experiences and male student voices, are provided for how to best meet the needs of male students in MFT training programs. These recommendations are (1) be aware of men's experiences and don't assume silence means disinterest, (2) develop depth in clinical training on men's issues, (3) incorporate theories of masculinity into curriculum, (4) engage male students in the training process, and (5) provide support to male students through mentorship and support groups.     

Theoretical Purity Versus Theoretical Layering in Marriage and Family Therapy

There seem to be two competing streams of thought about the use of theory in the marriage and family therapy literature: theoretical purity versus integrationism. We examined influence of theoretical orientation on client experience in therapy. Level of academic training (masters' versus doctoral degree) was investigated as a possible confounding variable. Results suggest that therapists in private practice are less inclined to practice pure forms of therapy.