Increasing Accessibility in Couple and Family Therapy Training: Incorporating Universal Design for Instruction

In the last three decades the number of US graduate students with disabilities has increased exponentially. Institutions of higher education have responded by developing and implementing multiple programs and initiatives to meet the needs of this population. One initiative, Universal Design for Instruction (UDI), is believed to have considerable promise. There is a lack of marriage and family therapy (MFT) literature on how to develop and implement pedagogical strategies for students with disabilities and diverse learning styles. Thus, UDI has the potential to enable MFT educators to increasingly foster inclusivity and provide accessible educational experiences for all students, including those with disabilities. When correctly incorporated UDI should diminish the need for individualized accommodations and increase the accessibility of courses and clinical training. We provide a synopsis of the history and philosophy of UDI and describe strategies for applying its nine principles to MFT education.     

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.     

Family Dynamics and AIDS Phobia: A Case Study

The author introduces and defines AIDS phobia. He illustrates the hypochondria type of AIDS phobia from a combined individual, couple, and family treatment perspective. He describes the treatment process and outcome after an effective countertransference-based intervention, connects the individual manifestations of the index patient's illness to the family dynamics, and concludes with an analysis of the multigenerational contributions to the individual's psychopathology.     

Ethics in Case Conceptualization and Diagnosis: Incorporating a Medical Model Into the Developmental Counseling Tradition

In this literature review, the author focuses on several ethical considerations in case conceptualization and diagnosis, including diagnostic training and competence. Meeting the American Counseling Association's (1995) ethical standard for diagnostic training has several ethical implications for counselors, counselor educators, and supervisors. For counselors who might struggle with how to meet their ethical responsibilities in diagnosis but who want to remain true to their developmental counseling emphases, the author discusses some of their concerns, the implications of and possible approaches to this aspect of their work. Conclusion Yalom (2002) asked a poignant question of counselors in his book, The Gift of Therapy: “If you were in personal psychotherapy or are considering it, what DSM‐IV diagnosis do you think your therapist could justifiably use to describe someone as complicated as you?” (p. 5). This question and continued dialogue about the ethics and implications of diagnosis are essential aspects of diagnostic training. Yalom's poignant and deeply personal question seems especially appropriate for increasing a counselor's empathy toward the client's sensitivity and vulnerability during the diagnostic process. Counselor educators might ask how one remains true to a developmental model of counseling while adhering to the ethical and accreditation standards of teaching the DSM's medical model of diagnosis. Counselors may also question how to use diagnosis ethically and empathically. Seligman (1999) recommended that clinicians view the DSM as one of many important sources of information about a person. Furthermore, counselors should seek to incorporate diagnostic information into a holistic context, recognizing that a diagnosis does not reflect the totality of the client. Some counselor educators have advised students to integrate the DSM model into their work with clients rather than abandoning their developmental roots (Waldo et al., 1993). Some counselors may not actually put their diagnoses in writing; Seligman believed, however, that thinking diagnostically may assist counselors in determining the best approaches to help clients and to help clients help themselves. This clinical and ethical debate about how, and in fact, whether, to integrate the medical model of the DSM and the developmental origins and distinctiveness of counseling continues. However, the CACREP (2001) standards, managed care systems, and other forces have pushed counseling professionals toward a medical model by mandating counselor knowledge and use of the DSM. Whatever a counselor's stance and behavior on client assessment and diagnosis may be, the literature presented in this review and discussion seems to suggest a need for heightened sensitivity to, preparation for, and accuracy in all facets of client assessment, especially diagnosis.     

Clinical Guidelines for Working With Stepfamilies: What Family,Couple, Individual,and Child Therapists Need to Know

This article draws on four decades of research and clinical practice to delineate guidelines for evidence‐informed, clinically sound work with stepfamilies for couple, family, individual adult, and child therapists. Few clinicians receive adequate training in working with the intense and often complex dynamics created by stepfamily structure and history. This is despite the fact that stepfamilies are a fundamentally different family form that occurs world‐wide. As a result many clinicians rely on their training in first‐time family models. This is not only often unhelpful, but all too often inadvertently destructive. The article integrates a large body of increasingly sophisticated research about stepfamilies with the author's four decades of clinical practice with stepfamily relationships. It describes the ways in which stepfamilies are different from first‐time families. It delineates the dynamics of five major challenges stepfamily structure creates: (1) Insider/outsider positions are intense and they are fixed. (2) Children struggle with losses, loyalty binds, and change. (3) Issues of parenting, stepparenting, and discipline often divide the couple. (4) Stepcouples must build a new family culture while navigating previously established family cultures. (5) Ex‐spouses (other parents outside the household) are part of the family. Some available data are shared on the impact of cultural and legal differences on these challenges. A three‐level model of clinical intervention is presented: Psychoeducational, Interpersonal, and Intrapsychic/Intergenerational Family‐of‐Origin. The article describes some “easy wrong turns” for well‐meaning therapists and lists some general clinical guidelines for working with stepfamily relationships.     

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."     

Intergenerational Suicide and Family Dynamics: A Hermeneutic Phenomenological Case Study

A phenomenological case study of a family in which the father committed suicide following incarceration and an adult daughter also committed suicide years later is described. This study used an embedded design to triangulate multiple sources of data (family documents and interviews with survivors) within the study of a single family. Four themes emerged to describe the relational dynamics between the father and adult daughter: (a) Mirroring, (b) Caretaking, (c) Death, and (d) Suicide. Four themes emerged from interviews with survivors about their coping process: (a) Ongoing Grief process, (b) Media Exploitation, (c) Separation and Transformation, and (d) Forgiveness. Results are discussed in terms of prevention and family processes in coping with suicide.     

Feedback in Couple and Family Therapy: A Randomized Clinical Trial

Routine Outcome Monitoring (ROM) is recommended as a psychotherapy procedure to serve as clinical feedback in order to improve client treatment outcomes. ROM can work as a warning signal to the therapist if the client shows signs of no change or deterioration. This study has investigated whether any difference in outcome could be detected between those clients in couple and family therapy who used the Systemic Therapy Inventory of Change (STIC) feedback system (ROM condition) versus those who were offered treatment without the use of STIC (“treatment as usual” or TAU condition). A sample of 328 adults seeking couple and family therapy in Norway was randomly assigned to ROM versus TAU conditions. Outcome measures were The Outcome Questionnaire–45 and The Revised Dyadic Adjustment Scale. The results demonstrated no significant differences in outcomes between the ROM and TAU. Possible explanations of this result related to design and implementation issues are discussed.     

IV. A Family Group Therapy Technique for a Stalemate in Individual Treatment

Abstract

This paper explores the trend away from offering process-oriented groups on inpatient units, given decreasing lengths of stay, increasing acuity levels, and current biases toward psychoeducational groups and cognitive-behavioral treatments. A model for doing process-oriented groups that provides a structure while allowing a theme to emerge and maximal interaction to take place is presented. A case is made for the benefits of process-oriented inpatient groups as compared to, and complementary with, psychoeducational, cognitive, and behavioral approaches. Clinical vignettes illustrate typical themes and dynamics emerging in process-oriented inpatient groups.     

Family Focused Treatment for Patients with Bipolar Disorder in Turkey: A Case Series

Family-focused therapy (FFT) is a 9-month, 21-session structured psychoeducational treatment for bipolar disorder. Several US-based studies have documented its efficacy as adjunctive to medication for depression stabilization and relapse prevention. However, FFT has never been applied outside of the United States. The objective of this case series is to explore the applicability of FFT in a non-Western culture. Ten patients with bipolar disorder and their family members attended the 9-month FFT as adjunctive to pharmacotherapy in an outpatient specialty clinic in Izmir, Turkey. Patients improved in Global Assessment of Functioning Scores and Clinical Global Impression Scores from pre- to posttreatment. Case studies are given, which illustrate the differences between Western and non-Western families coping with bipolar disorder. FFT was easily applied to a Turkish sample with few changes in format or focus. Adaptations included substitution of oral for written therapeutic tasks or homework assignments. Randomized controlled trials are needed to test the clinical effectiveness of FFT and other psychosocial interventions in non-Western cultures.     

Clinical Judgment in Case Conceptualization and Treatment Planning Across Mental Health Disciplines

This study compared clinical judgment on case conceptualization and treatment planning (TP) tasks among psychologists, mental health counselors, and social workers using Clinical Treatment Planning Simulations depicting anxiety and affective disorders. Orientation and work setting did not significantly influence judgment; experience exerted a “modest” curvilinear effect Mental health counselors scored higher than social workers and similar to psychologists on both tasks. The best predictors of TP scores for the anxiety disorder were interventions addressing stress management and family dynamics; strong predictors for the affective disorder included focus on family dynamics and the therapeutic relationship. Implications of findings for training are discussed.     

Individual and Family Growth: A Gestalt Approach

Gestalt therapy is described as a comprehensive framework of theory and techniques for experiential family therapy. Like other experientially oriented therapies, it is systems-oriented, immediate-experience-oriented, and affect-oriented. Unlike others, this method regards the client system's emergent processes as the central focus, and it emphasizes that growth occurs as the family and its members are helped to greater self-awareness and responsibility for their own functioning.     

A Conceptualization and Test of the Influences of Individual Differences in Goal-Setting Situations1

This research tests a hypothesized model of the relationships among several individual differences and variables associated with the setting of goals. Participants were randomly assigned to a self-set goal condition, or to moderately or very-difficult assigned-goal conditions. By aggregating scores of performance, personal goals, ratings of self-efficacy, and goal commitment over multiple goal-setting and task-performance occasions, the overall relationships among these variables and need for achievement, self-esteem, and locus of control were determined. Results provide strong support for Locke and Latham's (1990a, 1990b) model of the goal-performance relation, but fail to support the hypothesized role of individual differences. The implications of these findings and individual differences in goal-setting situations are discussed.     

Psychoanalytic Models of the Mind for Couple and Family Therapy

This paper describes an object relations theory of mind that highlights the interactive origin of psychic function and the beginnings of mental structure in the infant's relationships within the family group. Based on this model, psychoanalytic family and couple therapy employs the interactions between family and therapist to detect and work with developmental failures in holding and containment, skewed family projective identification, and attacks on linking, which characterize pathological and traumatized families. The coming together of transference generated by the family as a group and the therapist's countertransference are the fulcrum on which such therapy turns. An extended vignette of a session is used to illustrate the application of object relations theory to the therapeutic process of family therapy.     

The Infertility Resilience Model: Assessing Individual,Couple, and External Predictive Factors

Resilience in couples experiencing infertility is critical to decrease the impact of infertility-related stress and sustain positive interactions and collective perceptions in couples. The Infertility Resilience Model (IRM) presented in this article provides a framework within which various individual, couple, and external factors that influence resilience can be understood. Although numerous approaches have been applied to infertility, few of them have examined resilience and the interconnections between individual, couple, and external influences. The concepts and connections within the model can be used by clinicians for assessment and interventions when working with couples facing infertility.