Family systems training in psychiatric residencies

Both extensive research and common sense dictate that attention to families is necessary for appropriate care of psychiatric patients. However, training in family skills has often been difficult to integrate into psychiatric residency programs because of conflicting paradigms, turf battles, constraints of time and money, and confusion over whether family-centered care or family therapy should be taught. Current changes in residency accreditation mandate that family skills (not necessarily family therapy in its sophisticated form) be part of all residency programs. This article reviews the history of systems training in residencies, current accreditation requirements, and the GAP proposal for family systems skills, knowledge, and attitudes that that are teachable within the limited time available to residents. The application of these core skills is described using a case example and formulation. Challenges in teaching and ways of overcoming programmatic constraints are outlined.     

Mindfulness training in stuttering therapy: a tutorial for speech-language pathologists

The use of mindfulness training for increasing psychological well-being in a variety of clinical and nonclinical populations has exploded over the last decade. In the area of stuttering, it has been widely recognized that effective long-term management often necessitates treatment of cognitive and affective dimensions of the disorder in addition to behavioral components. Yet, mindfulness based strategies and their possible usefulness in stuttering management have not been described in detail in the literature. This article seeks to engage professionals who treat stuttering in a conversation about the possible usefulness of incorporating mindfulness training into stuttering management. A review of the literature reveals that there is a substantial overlap between what is required for effective stuttering management and the benefits provided by mindfulness practices. Mindfulness practice results in decreased avoidance, increased emotional regulation, and acceptance in addition to improved sensory-perceptual processing and attentional regulation skills. These skills are important for successful long-term stuttering management on both psychosocial and sensory-motor levels. It is concluded that the integration of mindfulness training and stuttering treatment appears practical and worthy of exploration. Mindfulness strategies adapted for people who stutter may help in the management of cognitive, affective, and behavioral challenges associated with stuttering.Educational objectives: Readers should be able to: (1) describe what mindfulness is and how it is cultivated; (2) identify the benefits that can be produced from mindfulness practice; (3) summarize how the benefits of mindfulness practice parallel what is often required for effective long-term stuttering management; and (4) identify specific mindfulness techniques that can be taught in stuttering therapy and explain their rationale.     

Action models—learning by doing

The aim of this workshop was to demonstrate experientially how action models can be used: to highlight particular themes; to study ongoing interactional patterns of the family system; to allow patterns of behaviour and communication to emerge along with the consequences of that pattern; to focus on the process rather than the content; to find the strengths and resources of the family; and to offer the opportunity of practising new skills and to gain insight through experience. Action techniques are specific acts or actions the therapist engages in to implement a strategy. Action is a deliberate intervention which will provide material shared with the family and therapist. Five different experiential exercises were demonstrated for use in family therapy training or in family therapy sessions.     

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.     

Training in family therapy: perceptual, conceptual and executive skills.

This paper presents a comprehensive and detailed outline of family therapy skills to aid in providing a more precise focus in the training of clinicians in family therapy. The skills are based on an integrated treatment model within a systems framework. Four major functions performed by a family therapist are separated and are further differentiated into general therapeutic competencies. Specific perceptual, conceptual, and executive skills are described in the form of instructional objectives and are listed under each competency. Occasional clarifying notes or examples are cited along with particular skills. Clinicians and trainees should find this outline a useful guide in skill development.     

Consultant Problem Understanding as a Function of Training in Interviewing to Promote Accessible Reasoning

The focus of this article is on how consultants develop a “high-quality” understanding of a teacher's presenting problem situation from interviewing them. A longitudinal quasi-experimental study was conducted with 10 graduate students enrolled on an accredited training program in school psychology in which interviewing and problem-solving skills were taught and practiced. Eight individuals who had been selected for the same training program but who had not enrolled acted as a comparison group to measure possible practice effects. The results indicated that following training consultant use of statements designed to reveal their reasoning to the teacher significantly increased, and was highly correlated with the quality of their subsequent written analyses of the teacher's problem situation.     

Jugenddelinquenz - Aktuelle Präventions - und Interventionskonzepte

This article presents an overview on the concepts and the outcomes of current prevention and intervention measures for juvenile delinquency and offender rehabilitation. The main focus is on a discussion of recent evaluation results. Social skills training, parent training programs, family-oriented early intervention, and multimodal school-based programs are discussed as prevention measures. Cognitive-behavioral and family therapy as well as diverse concepts of offender rehabilitation (e.g., boot camps) are delineated as intervention measures. The article concludes with an integrated evaluation of these results and a discussion of general theoretical and strategic issues.     

Prevention of marital instability and distress. Results of an 11-year longitudinal follow-up study

Divorce and destructive couple conflict are major risk factors for many forms of dysfunction and psychopathology in the family. Couple relationship education has been offered in an attempt to reduce those risks and enhance couple outcomes. The current effectiveness study had two aims: to assess (a) the long-term effects of relationship education and (b) the ability of partners to remember the skills typically taught during the communication skills training. One hundred and one couples from two studies, in which the effectiveness of the EPL (Ein Partnerschaftliches Lernprogramm für Paare [A Learning Program for Married Couples]) was investigated, were followed-up 11 years after the training. In the first study, EPL-takers had a significantly lower divorce and separation rate (27.5%) than non-EPL-takers (52.6%). This finding was replicated in a second study, showing a 20% dissolution rate in EPL-takers. For those couples still together, the rate of happy relationships was 80% at the eleven-year follow-up - thus, there is optimism for longer married couples who are willing to focus on improving their relationships. Only about 55% of the partners could remember at least one speaker skill whereas 70% remembered at least one listening skill taught during EPL. Consequences for prevention programs in the couple domain are discussed.     

The use of co-working (co-therapy) as a training method

This paper formed the basis of a Workshop at the A.F.T. Conference 1981, although the bulk of the theoretical material was not presented in the Workshop. The primary aim of the Workshop itself was to enable participants to think about how they themselves would use the co-working method as a way of training and to test these thoughts out to some extent in role-play.
The experimental part of the Workshop fell into two sections. In the first the aim was for participants to consider in pairs what they might wish to teach by this method and how; and in the second it was intended that they test out in pairs an attempt to teach a specific aspect of family therapy.
In practice members found in the first part some of the difficulties that this method presents, as shown in my research, and thus for the second part they felt it essential to focus on the issue of developing a contract between the two potential co-workers in order to clarify and confirm the nature of the training relationship. This was no doubt as it should be, since there is evidence that to press ahead with trying to teach a method in this close working relationship when there are substantial problems in, or uncertainty about the relationship can be disruptive. Hence the workshop as a whole was much concerned with the nature of the training experience rather than the actual transmission of family therapy skills.     

Transparency and self-disclosure in family therapy: dangers and possibilities

Therapy is a paid intimate relationship that thrusts clients and therapists into navigating personal and professional boundaries. When, where, why, and how is it appropriate and ethical for family therapists to be transparent, and when is it damaging? Theorists take varied stances from Haley's position of tight boundaries around therapist disclosure—whether in treatment or training—to the narrative viewpoint that therapists should be transparent about models of therapy, personal values, and life experiences that inform their practice and beliefs. However, these positions are not research based, and theorists who support disclosure offer few guidelines other than general statements. This article examines the history of ideas about disclosure in six major family therapy models, and the dangers and possibilities of transparency. It looks at the research on self‐disclosure in individual therapy and whether and how it could apply to family therapy. Guidelines are proposed that take into account the multiple social identities of therapists and clients, and issues of safety and transparency.     

The implementation and adoptability of behavioral skills training in a university career center

We evaluated the extent to which staff at a university career center (a) already used, (b) could be taught to use, and (c) might continue to use behavioral skills training (BST) when teaching interview answers to college students. We used a nonconcurrent multiple baseline design across three staff‐student dyads to assess the extent to which staff implemented BST and students provided appropriate answers before and after training. Results showed that interview training at the career center typically consisted of few BST steps, but staff could be taught on how to implement BST. All staff rated BST as an acceptable and effective form of interview training, but only one indicated that he or she was likely to adopt BST at the career center.     

University faculty preparation of students in using natural environment practices with young children

155 university faculty teaching students in physical therapy, occupational therapy, speech and language pathology, early childhood special education, or multidisciplinary studies programs were surveyed to assess how the students were taught how to use everyday family and community activities as natural learning opportunities for young children. Analysis showed that the faculty provided very little training in using community activity settings as contexts for children's learning and that physical therapy faculty provided less training in using natural environments as sources of children's learning opportunities than faculty in the other disciplines.     

Pyramidal training for families of children with problem behavior

The pyramidal training model was extended to multiple family members of children with behavior disorders. Three primary caregivers were taught to implement individualized treatments for problem behavior. They were then taught how to use various instructional strategies (e.g., prompting, feedback) to teach 2 other family members to implement the treatment. Results showed that pyramidal training was effective in increasing caregiver implementation of treatments across three families.     

How Do Experienced Family Therapists View Their Practice? An Exploratory Assessment of Clinical Skills and Their Relation to Theories of Family Therapy

This study examines the fit between theory based therapeutic skills and the perceptions of experienced therapists about their own skills. Participants responded to a measure of family therapy skills. Of the generic skills, two factors were identified which cut across many areas of practice. For the theory specific skills, two factors were identified which cut across four theories of family therapy. One was consistent with an expert style of therapy and the other reflected a collaborative approach to practice. These findings suggest that clinical training in family therapy should develop ways to train clinicians to match their clinical practice with client needs over theory based models.     

Evaluation of a telehealth parent training program in teaching self-care skills to children with autism

The present study used synchronous video conferencing to remotely deliver a behavioral skills training-based (BST) parent training program to 3 parents of children with autism in the family home. Parents were taught to implement graduated guidance to teach their children several important self-care skills. Parents did not correctly implement graduated guidance after receiving detailed written instructions only. After parents received the BST parent training package, however, all parents implemented graduated guidance with near-perfect levels of fidelity, and all children completed the targeted self-care skills with substantially higher levels of accuracy and independence. Furthermore, parents reported high levels of satisfaction with graduated guidance, the telehealth BST training package, and their children's ability to complete self-care skills.     

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.     

Short-term effects of behaviour therapy and hospital treatment of chronic alcoholics

Conditioning therapies, including electro-aversion treatment, of advanced states of alcoholism have not yielded an impressive record. There are probably several reasons for this state of affairs. Many studies have neglected the concurrent training of socially acceptable behaviour in the place of heavy drinking (Sobell and Sobell, 1972), and few studies have taught patients' relaxation or other anxiety-relieving methods (Blake, 1965). It may also be that treatment attempts have focused on conditioning fear or disgust to drinking stimuli themselves rather than covert, cognitive associations to various drinking situations (Claesson and Malm, 1973). The elements of electro-aversion therapy of alcoholism are little known and a number of problems remain to be investigated (Rachman and Teasdale, 1969; Hallam and Rachman, 1972). Among these problems are: how do we account for the different effects of electro-aversion therapy for different clients? How long-lasting are the effects of electro-aversion therapy?     

The family as its own reflecting team: a family therapy method

Social research has suggested that people, in general, tend to overestimate their skills and abilities. Interestingly, research has found that peers are better predictors of a person's behaviour than self‐assessment, suggesting that others know us better than we know ourselves. Family therapists should be aware that family members might not give accurate accounts of themselves. In order to overcome this problem, therapists should incorporate peer assessments into therapy. Reflecting teams and videotaping do incorporate peer assessments, yet these methods can be impractical. This article describes a method of family therapy using enactments as a means of setting up the family as its own reflecting team. The method suggests that the family and therapist switch roles several times during the enactment, and then encourages a discussion on the peer observations on how each person addresses a problem in the family. Case examples illustrate how feedback from peers promotes insights.     

AN INSTITUTIONAL STAFF TRAINING AND SELF-MANAGEMENT PROGRAM FOR DEVELOPING MULTIPLE SELF-CARE SKILLS IN SEVERELY/PROFOUNDLY RETARDED INDIVIDUALS

Although considerable attention has been given to the development of institutional staff training and management programs, the generalized effects of such programs on staff and resident behavior have seldom been examined. This study evaluated a program for teaching institutional staff behavioral training and self-management skills during self-care teaching sessions with severely and profoundly retarded residents. Following baseline observations in three self-care situations (toothbrushing, haircombing, handwashing), four direct care staff were sequentially taught to use verbal instruction, physical guidance, and contingent reinforcement in the toothbrushing program. During maintenance, staff were simultaneously taught to record, graph, and evaluate resident and their own behavior in the toothbrushing sessions. Staff were taught use of the training and self-management skills through a sequence of written instructions, videotaped and live modeling, rehearsal, and videotaped feedback. Observer presence and experimenter supervision were gradually decreased during the maintenance condition. Results indicated that during training and maintenance staff: (a) learned to use the training skills appropriately and consistently in the example situation (toothbrushing); (b) applied the skills in the generalization situations (haircombing and handwashing); and thereafter (c) maintained consistent and appropriate use of the skills with infrequent supervision. In addition, important changes in retarded residents' independent self-care responding occurred as staff training skills developed. Results are discussed in terms of their implication for future research and continued development of effective staff training and management programs.