Individual,Marital, and Family Therapy

Two therapists have recently suggested that marital therapy is either a shadow of individual therapy (Robert Harper) or eclipsed by family therapy (Jay Haley). We offer an apologia for marital therapy. We suggest that empirical evidence shows that it works. Further, clients often request it and resist a redefinition of marital concerns as individual or family problems. Finally, people value a focus on the marriage because (a) it blends individual rights and communal responsibilities and (b) it is the only voluntary relationship between dyads with the family. We conclude that marital therapy, when requested and appropriate, is legitimate and effective.     

Family Therapy After the Divorce: Developing a Strategy

Family therapy with the whole family after a divorce has taken place provides a unique opportunity for intervention. Though the spouses have legally terminated their relationship, their parenting function remains. However, this reality is often clouded by the emotional conflicts generated by the divorce. Family therapy can be useful in facilitating life in the post-divorce period. A four-part model for intervention is described. The first task is to redefine the family as existentially including all members. Next, generational boundaries are firmed in order to reduce the parentification process, often intensified by the parent's physical absence. Third, the family needs to have a replay of the history of the marriage to correct developmental distortions and offer a changce to mourn the loss of the intact family. Finally, the therapists attempt to facilitate an emotional divorce. A case study is presented to elucidate the manner in which these steps unfold in treatment.     

Evaluating Trainees' Skill Development: The Family Therapy Skills Checklist

Training competent therapists is the fundamental goal of supervisors. Supervisors and academic programs need to increase efforts to identify and operationalize therapeutic skills required for trainees. This study examines the Family Therapy Skills Checklist (FTSC) designed to assess therapists' conceptual, behavioral, and professionalism skills. The 315 separate evaluations by therapists-in-training and their supervisors' indicated a high level of inter-rater consistency and the ability to discriminate between advanced, struggling, and beginning therapists. Recommendations for further research are suggested.     

Defection, Termination, and Continuation in Family and Individual Therapy

Patients applying to a child study center over a period of one year were referred for either individual or family evaluation and therapy. The present study focused on comparative rates of defection (failure to appear for first session), premature termination (one to three sessions), and continuation (more than three sessions) of treatment. Structured interviews were conducted on the telephone to explore the reasons for termination or continued treatment. Three main findings emerged: (a) Drop-out rates for family therapy are significantly different than for individual treatment; (b) Major reasons for terminating or continuing treatment, in either modality, seem related to patients evaluations of their therapists; (c) Fathers of patients play a pivotal role in determining whether families terminate or continue in treatment.     

Individual Differences in the Effectiveness of Error Management Training for Developing Negotiation Skills

This study investigated whether the effectiveness of an error management approach to training negotiation knowledge and skill depended on individual differences in conscientiousness, extraversion, and openness to experience. Participants were randomly assigned to two training programs that incorporated key elements of an error management and behavioral modeling approach to training, and were trained in the complex interpersonal skill of negotiation. At the end of training, declarative knowledge acquisition, procedural knowledge acquisition, declarative knowledge retention, and transfer performance were assessed at different points in time. Results suggested that the effectiveness of the error management training program was dependent on individual levels of conscientiousness and extraversion. For several learning outcomes, the performance of highly conscientious and extraverted individuals was superior in the error management condition, while the performance of less conscientious and introverted individuals was superior in the behavioral modeling condition. The implications of these findings, and suggestions for future research, are discussed.     

An Ecological Approach to Enhancing Parenting Skills in Family Therapy

To increase the effectiveness of parent education interventions, family therapists can address those factors that shape the way in which parents interact with their children. This article presents ecological theory as a framework that can help clinicians expand the range of their parent training efforts. In order to assess the utility of ecological theory for clinical practice, the present study empirically explored the ways in which selected characteristics of parents, children, and the family context related to mothers' parenting behavior. Specific recommendations for family therapists who employ parent training techniques are offered.     

Meeting the Needs of Evidence-based Practice in Family Therapy: Developing the Scientist-practitioner Model

Effective models of clinical training have been and continue to be a primary topic of discussion in the field of family therapy, particularly given the needs of evidence-based practice. This article outlines the major historical and contemporary struggles of one such model of clinical training and practice: the scientist-practitioner model. Throughout the article, the principles of the scientist-practitioner model and evidence-based practices are compared and contrasted. Suggestions for overcoming the contemporary challenges faced by the scientist-practitioner in a family therapy practice or in an educational environment are discussed.     

In Pursuit of Sisterhood: Adult as a Resource for Combined Individual and Family Therapy

Therapists traditionally view brothers and sisters as rivalrous and self-seeking. Under carefully arranged conditions, however, siblings can learn to cooperate with each other to resolve important conflicts in family relationships. This case documents a dramatic change in the relationship between a 29-year-old woman and her father, the outcome of a three-step therapeutic intervention in which sibling dynamics were selectively used by the psychotherapist. As part of her individual therapy, the therapist first aroused the woman's discontent with her status as the neglected “baby of the family.” Next, a series of meetings were held with the woman and her three sisters that permitted resolution of their previous anger and misunderstandings, thus helping them to become a more cohesive group of sisters. The third step brought the sisters, now as allies both of the identified patient and of the therapist, into a constructive confrontation with the parents. This resulted in lasting personal change for the identified patient and improved relationships throughout the entire family.     

The Anorectic Process in the Family: A Six-Stage Model as a Guide for Individual Therapy

This article presents a conceptual framework for individual treatment with chronic anorectic patients. In the first part of the article, the six-stage model for the anorectic process developed over the past years by M. Selvini-Palazzoli and her team is briefly explained. After presenting the model, we then discuss some related concepts, namely, "family game," "rule," and "strategy." Finally, the therapeutic technique in individual treatment is discussed. Two basic assumptions underlie this technique: first, the therapeutic relationship is instrumental, its main purpose being to improve the patient's personal relations outside therapy; second, the focus of the treatment is on the strategic incapacity of the patient who is caught up in and unable to cope with the "concealed family game."     

Differences in Dropout Rates Among Individual, Couple, and Family Therapy Clients

The premature dropout of clients from therapy is an inefficient expenditure of mental health resources. This study examined differences in dropout rates among individual, couple, and family therapy clients. Data came from archived records at a marriage and family therapy clinic at a university in the United States. Results indicated that there were no significant differences in dropout rates, despite the use of multiple measures of dropout. Thus, from a mental health services perspective, administrators and clinicians can expect that dropout rates will remain fairly consistent across treatment modalities.     

Utilization of Individual versus Family Therapy Among Adolescents with Severe Emotional Disturbance

Service utilization patterns among children with severe emotional and/or behavioral disturbances are described for 89 children and families, interviewed at two time points across a 6-month period. Children received a greater number of individual therapy sessions than family therapy sessions, and children significantly decreased their levels of internalizing and externalizing behaviors. Family therapy was associated with decreases in internalizing behaviors when children reported outcomes. Individual therapy was not associated with changes in either internalizing or externalizing behaviors regardless of reporter. Symptom severity did not dictate whether children were provided individual or family therapy. Recommendations for individualized treatment plans are offered.