Brief strategic family therapy: lessons learned in efficacy research and challenges to blending research and practice

In this article, we present key lessons that we have learned from (1) a long program of research on an empirically supported treatment, brief strategic family therapy (BSFT), and (2) our ongoing research and training efforts related to transporting BSFT to the front lines of practice. After briefly presenting the rationale for working with the family when addressing behavior problems and substance abuse in adolescent populations, particularly among Hispanic adolescents, we summarize key findings from our 30-year program of research. The article closes by identifying barriers to the widespread adoption of empirically supported treatments and by presenting current work within the National Institute on Drug Abuse's Clinical Trials Network that attempts to address these barriers and obstacles.     

Barriers to treatment success in behavioral consultation: Current limitations and future directions

Behavioral consultation is a prominent indirect service model in the practice of psychology in the schools. Despite some empirical support for the use of behavioral consultation strategies, consultants frequently face a number of barriers to implementation of treatment in practice. This article outlines a number of these barriers in behavioral consultation, including the lack of standardization of consultation, lack of specific training of consultants, little or no consultee (teacher) training, problems surrounding target behavior identification, and external constraints to consultation. Each of these areas is described along several dimensions that need to be addressed in future research.     

Responding to problems: The roles of severity and barriers

In even the most satisfying relationships, couples face specific problems, varying in severity. Partners may strategically devote more time and effort to actively working on their most severe problems. However, actively addressing problems comes with risks, especially for partners who perceive barriers to leaving the relationship. Two studies of partners in seriously dating, cohabiting, and marital relationships examined responses to problems of varying degrees of severity and the role of barriers. In each, a positive association was found between the severity of problems and use of various strategies to address the problems. However, barriers to leaving the relationship moderated these associations, such that partners with more barriers to leaving were less likely to actively address their more severe problems.     

Clinical Experiences in Conducting Cognitive-Behavioral Therapy for Social Phobia

Several authors have identified a disconnect between psychotherapy research, including research on cognitive behavioral therapy (CBT), and real-world psychotherapy practice. This disconnect has several negative consequences, potentially including less-than-optimal practice standards as well as a lack of input from practicing psychotherapists on how research can be improved and made more relevant in their day-to-day clinical work. As part of an ongoing effort to engage practicing psychotherapists in a feedback loop with psychotherapy researchers, this study reports the results of a survey of CBT therapists who have used CBT in the treatment of social phobia (SP). The survey was designed primarily to document how often certain potential problems, identified by expert researchers and CBT manuals, actually act as barriers to successful treatment when CBT is employed in nonresearch environments. The participants were 276 psychotherapists responding to email, online, and print advertisements completing the online survey. Participants varied considerably in psychotherapy experience, work environment, experience in using CBT for SP, and in some ways varied in their usual CBT techniques when treating SP. Among the most prominent barriers identified by many of the participants were patient motivation, comorbidity, logistical problems (especially with exposures), patient resistance, and severity and chronicity of SP symptoms. These findings may be useful for psychotherapy researchers as areas for potential study. The results may also suggest topics requiring clinical guidelines, innovations within CBT, and dissemination of successful techniques to address the barriers identified here.     

Training Insight Problem Solving Through Focus on Barriers and Assumptions

Recent research has reported successful training interventions that improve insight problem solving. In some ways this is surprising, because the processes involved in insight solutions are often assumed to be unconscious, whereas the training interventions focus on conscious cognitive strategies. We propose one mechanism that may help to explain this apparent disconnect. Recognition of a barrier to progress during insight problem solving may provide a point of access to the tacit constraining assumptions that have misled the solution process. We tested this proposal in an experiment that examined the effects of different training routines on problem solving. The experiment compared four training routines, focusing either on barriers and assumptions combined, barriers alone, assumptions alone, or goals, with two control conditions. Outcomes were measured using eleven spatial insight problems. The results indicated that training that combined focus on barriers and assumptions was significantly more effective than all other conditions, supporting the proposition that recognizing and reinterpreting barriers may assist in surfacing the unwarranted assumptions that prevent problem solving.     

Therapist, Parent, and Youth Perspectives of Treatment Barriers to Family-Focused Community Outpatient Mental Health Services

This exploratory qualitative study describes treatment barriers to receiving family-focused child mental health services for youths with disruptive behavior problems from multiple perspectives. Data were collected during a series of focus groups and interviews, including: 4 therapist focus groups (n = 26), 3 parent focus groups (n = 14), and 10 youth (10–13 years) semi-structured interviews. Data analysis followed inductive, iterative processes typical of qualitative research using an editing style and thematic content analysis approach. Therapist, parent, and youth stakeholder participants discussed perceived barriers to effective treatment, the problems with current child outpatient therapy, and desired changes (i.e., policy, intervention, etc.) to improve mental health services. Results indicate similar themes around treatment barriers and dissatisfaction with services within and across multiple stakeholder groups, including inadequate service system support, lack of family involvement and feeling overwhelmed with the complexities of families’ needs; however, parents and therapists, in particular, identified different contributing factors to these barriers. Therapists highly endorse using family-focused therapy and desire parent participation; however, parents feel unsupported by their child’s therapist. Parents’ report feeling blamed and not heard by service providers which negatively impacts their attitude about service delivery, causing discomfort and resistance to participation in their youth’s treatment. Youth also discussed dissatisfaction with mental health services, specifically related to their direct experiences in therapy, and desired more active, directive family-focused approaches. Overall, stakeholders reported much frustration and dissatisfaction with current community-based outpatient child therapy services. Study findings can inform service provision, intervention development, and future research.     

心理学文化转向中的方法论难题及整合策略

近20多年来心理学的文化转向研究基本上扫清了许多外围障碍,但也暴露出了一些深层次的发展难题,如心理学的文化研究在实现科学观的转变过程中如何避免限制与泛化之问的矛盾：人类文化心理的普适性与差异性关系难以在实践操作层面上得到有效实现;后现代及全球化文化背景下加剧了心理学的对立与分歧。求得这一难题有效解决之关键在于改变滞后的科学观．深化阐述性与规范性心理文化层面研究的理论力度。     

Barriers between mental health services and Mexican Americans: An examination of a paradox

The paradox of underutilization of mental health services by Mexican Americans is critically examined. It is argued that Mexican Americans live under high levels of psychological and environmental stress that would ordinarily lead to mental health problems and an increased utilization of mental health services. A number of barriers to the use of mental health services by Mexican Americans are examined. Included among these barriers are such factors as the relationship between social class and treatment offered, stereotypes concerning Mexican American folk psychiatry, limitations imposed by language differences, and the effects of stereotypes between Anglo Americans and Mexican Americans. Paradoxical findings in some studies which show a positive perception of mental health services by Mexican Americans are seen to further underscore the need for more research on the Mexican American's position. Stereotypes and generalizations about Spanish-speaking and bilingual Mexican American's approaches to psychotherapy are challenged in the light of recent empirical findings. Recommendations for future research directions and for improving the delivery of mental health services are presented.     

Issues presented by mandatory reporting requirements to researchers of child abuse and neglect

Mandatory reporting laws, which vary slightly from state to state, require reporting by helping professionals when there is reasonable cause to suspect child abuse. Institutional Review Boards (IRBs) require researchers to warn subjects of this duty to report, which may have a chilling effect on subject rapport and candor. Certificates of confidentiality, in conjunction with other precautions, may reduce some barriers to valid research. Attempts to resolve problems created by reporting laws must produce the most valid research, while minimizing harm and distress to research participants, their families, and the researcher and meeting local and federal legal requirements.     

The impact of homelessness on children.

This article reviews and critiques community-based research on the effects of homelessness on children. Homeless children confront serious threats to their ability to succeed and their future well-being. Of particular concern are health problems, hunger, poor nutrition, developmental delays, anxiety, depression, behavioral problems, and educational underachievement. Factors that may mediate the observed outcomes include inadequate shelter conditions, instability in residences and shelters, inadequate services, and barriers to accessing services that are available. Public policy initiatives are needed to meet the needs of homeless children.     

The family check-up: a pilot study of a brief intervention to improve family functioning in adults

Many barriers exist for families seeking appropriate treatment for family problems. In an effort to minimize some of these barriers, we developed the Family Check-Up, a brief two-session family intervention. The Family Check-Up is based on the Drinker's Check-Up and consists of assessment, feedback, discussion, and goal setting. The purpose of the intervention is to help families identify and become motivated to make needed changes in any aspect of their family functioning. We conducted an open pilot trial of the Family Check-Up with 32 families. Our data suggest that the Family Check-Up (1) is sought out by the target audience, namely those with family problems; (2) is sought out by people with elevated depression symptoms or a history of treatment for depression or anxiety; (3) is feasible to conduct; (4) is acceptable to families; and (5) may be associated with changes in family functioning and depression symptoms over time. These results suggest that further research, particularly a randomized clinical trial, is warranted.     

What Prevents Adolescents from Seeking Help After a Suicide Education Program?

Perceived barriers to help-seeking among adolescents attending a suicide education program were examined. A total of 854 high school students in Colorado completed one of two questionnaires, measuring barriers to help-seeking for self or friend. The most prominent barriers for self were: inability to discuss problems with adults, self-overconfidence, fear of hospitalization, and lack of closeness to school adults. The most prominent barriers for troubled friends were: friendship concerns, unapproachability of school adults, fear of friend's hospitalization, and underestimating friend's problems. Results reveal multiple constraints limiting the program's utilization, supporting the need for comprehensive system approaches to suicide prevention.     

Implementation of the Wolverine Mental Health Program,Part 1: Adoption Phase

Residential treatment facilities (RTFs) are a first-line treatment option for juvenile justice-involved youth. However, RTFs rarely offer evidence-based interventions for youth with internalizing or externalizing mental health problems. Wolverine Human Services (WHS) is one of the first RTFs in the nation to implement cognitive-behavioral therapy (CBT) to enhance mental health care for their youth. This study outlines the preimplementation phase of a 5-year collaborative CBT implementation effort among WHS, the Beck Institute, and an implementation science research team. The preimplementation phase included a needs assessment across two sites of WHS to identify and prioritize barriers to CBT implementation. Of the 76 unique barriers, 23 were prioritized as important and feasible to address. Implementation teams, consisting of clinician and staff champions and opinion leaders, worked across 8 months to deploy 10 strategies from a collaboratively designed blueprint. Upon reevaluation of the needs assessment domains, all prioritized barriers to CBT implementation were removed and WHS’s readiness for CBT implementation was enhanced. This study serves as a model of a preimplementation process that can be employed to enhance the potential for successful evidence-based practice implementation in youth RTFs.     

Selling and Sales Management in Action: The Sales Force's Role in International Marketing Research and Marketing Information Systems

Many companies resist global markets because of seemingly insurmountable problems with these markets. Salespeople are often used successfully to gather market information. There is a wealth of market data that can be collected by a company's international sales force and distributors' sales force which can prove to be valuable in surmounting cultural and marketing barriers associated with global markets. The current paper discusses how and with what success U.S. multinational companies are using their international sales forces in gathering international marketing research data.     

Stigma and Barriers to Mental Health Care in Deployed Canadian Forces Personnel

Mental disorders are prevalent on deployed operations, but only a small fraction of those with problems access care due to a range of barriers. A survey measuring need for care, perceived barriers, and care-seeking propensity was administered to Canadian Forces personnel during deployment in Afghanistan. Complex characteristics of barriers to care on deployment were found: stigma had no association with care-seeking propensity; perceived structural barriers were associated with greater care-seeking propensity; and perceived structural barriers were greater in more isolated locations. Only negative attitudes toward care had the expected negative association with care-seeking propensity. Research and practical considerations are discussed.     

Getting Fathers Involved in Child-Related Therapy

Fathers are involved in treatment for child and family problems to a far lesser extent than are mothers. This article reviews the level of fathers’ inclusion in therapy, delineates possible barriers to fathers’ participation in child-related treatment, and discusses factors associated with fathers’ involvement in therapy. Empirically and clinically informed strategies to engage fathers in treatment are offered to help therapists increase fathers’ participation in the therapeutic process. Finally, future directions for clinically informed research in this area are discussed.     

The Role of Perceived Barriers in Career Development: A Social Cognitive Perspective

Recent research has verified the claim that high school and college students perceive a variety of career-related barriers. Lent, Brown, and Hackett's (1994, 1996) social cognitive career theory and Weiner's (1979, 1985, 1986) attribution theory are useful approaches to increase understanding of the role that perceived barriers play in career development. This article presents a brief overview of the primary components of each theory as they relate to career-related barriers, discusses counseling implications associated with each approach, and provides ideas for future research to explore the utility of these theories in explaining career-related barriers.