Research & clinical exchange

Abstract

Question: Family therapists are often called upon to do consultations to schools about children having social and educational difficulties. In what ways is the family therapist's role different when he or she is called in to consult as an “outsider’ to the school system about a particular child whom he or she does not know, compared to being called upon by the school for advice about a child who is already being seen in treatment by that therapist?     

Christian Pastors’ Perspectives and Insights on the Practice of Family Therapists Referring LGB Clients: Exploring the Role of Religion

Abstract

This qualitative study explored Christian pastors’ perceptions and insights for family therapists who refuse to work with lesbian, gay, and bisexual (LGB) clients by consistently referring them. Twenty-one pastors from diverse Christian traditions were interviewed. Thematic analysis identified the following themes related to the pastors’ perceptions of the practice of referring LGB clients: (1) Best Interest of the Client and Therapist, (2) Discriminatory Practice, and (3) No Referrals will be Provided. The following themes represent pastors’ advice for family therapists: (1) Develop a Well-Thought-Out Referral Plan; (2) Be Accountable for Your Own Beliefs; and (3) Engage in Conversations.     

Qualitative meta-analysis of insight events in psychotherapy

Purpose: This study reports on a qualitative meta-analysis examining the phenomenon of insight into psychotherapy. Method: Studies (n?=?7, covering 15 insight events of 15 clients) were selected that examined significant events in psychotherapy leading to insight using session recordings and Interpersonal Process Recall interviews with clients and therapists. A conceptual organization of the data using a matrix grid consisting of three domains according to data origin (client process, therapist process, and their interaction) and three domains according to events’ sequence (context, event and key intervention, and impact) was established. Results: Key processes were identified that lead to insight events in psychotherapy. Two distinct types of events according to their main impacts as reported by the clients were identified: Painful/Poignant Insight where clients realized something that was painful, often evoking feelings of sadness or undifferentiated upset containing sadness and hurt; and Self-Asserting/Empowering Insight that led to an impact characterized by a sense of self-assertion and empowerment on the client’s part. A reasonably good alliance and vulnerability on the client’s part represent the context for insight events as does the client’s quest for self-understanding. The therapists’ key interventions in the event leading to poignant/painful insight contain either empathic reflection or collaborative interpretation. In empowerment/self-assertive insight events the therapists offer supportive, validating reframing promoting positive experience. In both types of events the therapist and the client work on consolidating insight. In some events, therapists emphasized cognitive or problem solution focused impacts, while clients emphasized emotional impacts. Some events contained emotional avoidance on the part of the client or therapist thus not realizing the full potential of the event.     

Latinx LGBQ Young Adults’ Coming-Out Experiences

Abstract

Marriage and family therapists (MFTs) must be culturally competent and sensitive to serve the growing Latinx population in the United States (US). To understand the sexual orientation disclosure experiences of Latinx LGBQ individuals, we interviewed 10 individuals. Using Moustakas’ (1994) phenomenology, we identified six themes: disclosure impacts family closeness, family members experience disbelief, control over the disclosure influences young adults’ perception of their coming-out experience, the coming-out experience is influenced by religion, the coming-out experience is influenced by traditional gender roles, and disclosure of sexual identity is a continuous process. We discuss clinical implications and areas for future research.     

Cause and responsibility: towards an interactional understanding of blaming and 'neutrality' in family therapy

This paper aims to shed light on the ways in which 'neutrality' is both produced and resisted by socially competent actors in family therapy sessions. It draws upon recent and previous papers in this journal ( Stancombe and White, 1997; Stratton, 2003a, 2003b ), which highlight the importance of blame in therapeutic encounters. When families come to therapy, individual members frequently deliver competing accounts about the family troubles and who is to blame for them. This produces particular challenges for the therapist. We examine the practices of therapists in managing accountability in the session and in their own discussions. Family therapists operate with a professional ethic of neutrality, or multi-partiality. This paper is concerned with the linguistic strategies used by therapists to deal with overtly blaming accounts, how these strategies are responded to by family members in talk-in-interaction and how therapists go about crafting accountability-neutral versions. We show that the social and moral context of family work makes the therapist's job of communicating multi-partiality precarious. In producing accountability-neutral versions of families' troubles, therapists are forced to make practical-moral evaluations of competing versions of events. We conclude by arguing for a more explicit engagement with the moral nature of therapeutic practice.     

Gender Biases and Therapists’ Conceptualization of Couple Difficulties

In spite of the fact that gender issues have played an important role in many family therapy training programs, little research has been developed to explore the effects of gender and gender biases in therapists’ conceptualizations of client problems. This study explores beginning and advanced marriage and family therapy (MFT) student’s inclusion of gender in the conceptualization of a clinical case. To examine clinician’s thinking, 32 therapists (18 beginning MFT students and 14 advanced MFT students) were asked to 1) view the first 20 minutes of an intake interview conducted by a sex therapist, and 2) identify the couple’s central issues. Qualitative and quantitative analyses were used to explore constructs associated with therapists considerations and inclusion of gender and cultural issues in their conceptualizations of marital difficulties. Results revealed that trained MFT students who considered gender may have analyzed gender issues more extensively than untrained MFT students. In addition, results of qualitative analysis of participant critiques revealed subtle forms of gender and cultural biases. Discussion focuses on how these biases, some of which are linked to clinical theory, can lead to differential expectations and inequality in the treatment of men and women in couple therapy. Implications for clinical training, curriculum development, and future research are also discussed.     

Factors Influencing Occupational Competence in Schizophrenia

Abstract

Objective: To explore and compare the perception of productive activities (studies, work) held by young adults with schizophrenia and their therapists.

Method: An exploratory qualitative study was carried out using the Model of Competence (Rousseau, 2003). Nine client-therapist dyads were recruited. Data collected were transcribed, coded, and processed with QSR.N'VIVO (2002).

Results: Therapists and clients agree about the personal characteristics (e.g., motivation, coping) and activities (e.g., prior work or study experiences) that have positive (e.g., social skills) or negative influence (e.g., symptoms of schizophrenia) on competence in productive activities. Their perceptions differ about the environmental characteristics that influence competence: some elements are mentioned only by clients (e.g., work environment) or therapists (e.g., using community resources).

Conclusion: The framework offered by a specialized clinic can promote exchanges and the congruence of perceptions between therapists and clients. Interventions focusing on the environment should be further developed in relation to productive activities.     

On French listeners’ ability to use stress during spoken word processing

Previous studies have suggested that French listeners experience difficulties when they have to discriminate between words that differ in stress. A limitation is that these studies used stress patterns that do not respect the rules of stress placement in French. In this study, three stress patterns were tested on bisyllabic words (1) the legal stress pattern in French, namely words that were unstressed compared to words that bore primary stress on their last syllable (/?u?i/-/?u’?i/), (2) an illegal stress location pattern, namely words that bore primary stress on their first syllable compared to words that bore primary stress on their last syllable (/’?u?i/-/?u’?i/) and (3) an illegal pattern that involves an unstressed word, namely words that were unstressed compared to words that bore primary stress on their first syllable (/?u?i/-/’?u?i/). In an ABX task, participants heard three items produced by three different speakers and had to indicate whether X was identical to A or B. The stimuli A and B varied in stress (/?u’?i/-/?u?i/-/?u’?i/), in one phoneme (/?u’?i/-/?u’???/-/?u’?i/) or in both stress and one phoneme (/?u’?i/-/?u???/-/?u’?i/). The results showed that French listeners are fully able to discriminate between two words differing in stress provided that the stress pattern included an unstressed word. More importantly, they suggest that the French listeners’ difficulties mainly reside in locating stress within words.     

Fat Women’s Experiences in Therapy: “You Can’t See Beyond…Unless I Share It with You”

Abstract

This article reports the results of a qualitative exploration of fat women’s experiences with weight-related microaggressions in psychotherapy. We conducted semi-structured interviews with 15 women about their weight-related experiences as therapy clients and asked for their advice to therapists who work with fat women. We used a general inductive approach to code the data into themes and found that common microaggressions included therapists who overly focused on weight, therapists who appeared to be less interested in clients because of their weight, and dissatisfaction with waiting room seating options. Participants advised therapists to allow their clients to initiate conversations about weight. Results suggest the need for increased awareness of: (a) how clients’ weight may impact therapists’ attitudes and choice of interventions and (b) how weight might influence fat clients’ in-session presentations.     

Psychotherapists' dreams about their patients

Abstract This study examines therapists’ dreams about their patients from the Jungian and the relational perspectives. Few clinical and empirical references to this subject are to be found in the literature. In the present study 31 dreams were collected from 22 therapists. Dreams were collected using anonymous self‐report inventory. The research focused on three theoretical research questions: 1. What themes appear in the manifest content of therapists’ dreams about their patients? 2. What contributions are made by Jungian interpretation of therapists’ dreams about their patients? 3. To what extent are masochistic contents present in the manifest content of therapists’ dreams about their patients? The first question was addressed using categorical content analysis of a) themes common to different dreams and b) pre‐determined themes for all dreams. The third research question was addressed using Beck's (1967) ‘Masochistic Dream’ measure. Results: Among the themes common to different dreams were: therapist‐patient role reversal; therapist and/or patient attends and remains in meeting, departs/doesn’t depart; cancellation of therapy session; sexuality between therapist and patient; aggression; presence vs. absence; non‐verbal relationship and communication; time; driving vs. stopping. With regard to pre‐determined themes it was found that in 20 of the 31 dreams, the therapist had a negative experience and was characterized as vulnerable. Likewise it was found that 26 out of 31 dreams took place in either a) a street, a road, a route, a corridor; b) en route to somewhere; c) a therapy room and/or building; d) a house. With regard to the contribution of Jungian interpretations of the dreams it was found that 17 of the dreams had diagnostic and prognostic elements, 4 of which were initial dreams, 9 of them were compensatory dreams and in 14 it was found that the patient represents the shadow of the therapist. With regard to the third question it was found that 18 of the 31 dreams met Beck's (1967) criteria for masochistic dreams. The theoretical discussion examines the findings from a Jungian perspective, with an emphasis on also understanding the dream in terms of its expression of relational aspects of the therapist‐patient relationship. The findings affirm the presence of the ‘wounded healer’ archetypes in therapists’ dreams about their patients. The results of the study indicate that therapists’ dreams about their patients can be a valuable tool for deepening understanding of the therapeutic relationship and process.     

Children and Adolescents with Medically Unexplained Symptoms: A Systematic Review of the Literature

Abstract

Medically unexplained symptoms (MUS) in children and adolescents are confounding and concerning for patients, parents, and health care practitioners. Our goal was to review and summarize the literature for family therapists working with a diverse, challenging patient population coping with MUS. A search of multiple databases from 1994 to 2018 was conducted using MUS and related terms. The literature was then organized into subcategories based on its relevance to family therapists, particularly medical family therapists collaborating with primary care physicians. We conclude with a discussion about gaps in the literature and suggestions for clinical management.     

A Systemic Treatment of Families with a Child Diagnosed with Autism Spectrum Disorder Using a Narrative Lens

Abstract

Autism Spectrum Disorder (ASD) is a neurodevelopment disorder that now affects one in 59 children, a 15% increase from the 2012 report. Although there have been numerous studies on the treatment of ASD, interventions focus primarily on the individual diagnosed with ASD. Marriage and family therapists’ (MFT) are in a unique position to handle the systemic dynamics of ASD. As a result, many MFTs find it difficult and outside their scope of practice to work with these families. We will explore aspects of narrative family therapy, conceptualization, and interventions, giving the reader a base understanding of how to implement narrative therapy while working with this population.     

A Microanalytic Case Study of the Utilization of ‘Solution-Focused Problem Talk’ in Solution-Focused Brief Therapy

Abstract

Solution-focused therapy (SFBT) is a popular therapeutic approach among family therapists. However, disputes about SFBT still arise, especially on problems. This study examines the function of problem talk in SFBT by using a microanalytic case study method. As a result, three categories were found: Eliciting, clarifying, and acknowledging problems. The problem talks initiated by the SF therapist showed a pattern associated with the solution talk and served as preliminary steps to be connected to the following solution talks. The results indicate that solution building is constructed not only through solution talk, but also through ‘solution-focused problem talk.’     

A Family Therapist's Guide to Bipolar III: Antidepressant-Induced Mania or Hypomania

This article explores the phenomenon of hypomania and mania induced by the treatment with antidepressants, sometimes called bipolar III. Family therapists need to be aware of this phenomenon because estimates are that between 3–10% of depressed individuals may be at risk for developing hypomania or mania when treated with antidepressants. The article discusses implications for family therapists, including their role in the prevention and early detection of antidepressant-induced mania or hypomania.     

Life story research: A relevant methodology for counsellors and psychotherapists

Aims: This paper introduces, describes and proposes life story research as an important, relevant and appropriate contribution to counselling and psychotherapy research. It shows how narrative knowledge is created and constructed through the stories people tell about their lived experiences and explores the concept of ‘narrative knowing’ (Bruner, 1986). Methods: Drawing on life story research with people who linked their history of problematic drug use with experiences of historic trauma/abuse, the paper contributes to the ongoing discussion related to the similarities/differences between therapy and research and what we might learn from each that informs the other. Implications for practice: The paper offers narrative ideas and practices as ways of researching matters of social and psychological importance. It suggests that therapists (and counselling researchers) could learn from what participants tell us about the therapeutic value of using life story methods which one participant described as helping him to face ‘out into the world, without unduly or specifically delving into, or focusing on [my] emotional state’. This learning may be particularly relevant for therapists working with traumatised clients.     

Beyond personal responsibility: Effects of causal attributions for overweight and obesity on weight-related beliefs,stigma, and policy support

Objective: The objective of this research was to compare the effects of different causal attributions for overweight and obesity, among individuals with overweight and obesity, on weight-related beliefs, stigmatising attitudes and policy support.

Design: In Study 1, an online sample of 95 US adults rated the extent to which they believed various factors caused their own weight status. In Study 2, 125 US adults read one of three randomly assigned online passages attributing obesity to personal responsibility, biology, or the ‘food environment.’ All participants in both studies were overweight or obese.

Main outcome measures: All participants reported beliefs about weight loss, weight-stigmatising attitudes, and support for obesity-related policies.

Results: In Study 1, biological attributions were associated with low weight-malleability beliefs and blame, high policy support, but high internalised weight bias. ‘Food environment’ attributions were not associated with any outcomes, while ‘personal responsibility’ attributions were associated with high prejudice and blame. In Study 2, participants who received information about the food environment reported greater support for food-related policies and greater self-efficacy to lose weight.

Conclusion: Emphasising the role of the food environment in causing obesity may promote food policy support and health behaviours without imposing the negative consequences associated with other attributions.     

Resiliency: A shift in our perception?

Abstract

As our clients often underestimate their own resources and potential, do helpers fall victim to the same phenomena? This article contends that helpers are often overly attentive to client deficits and pathology to the detriment of acknowledging family and other client strengths and resources brought into the therapeutic arena. Much of our professional training results in an overreliance upon pathological lenses which is to the disadvantage of both client and helper. Family therapists must remain vigilant to not becoming seduced into the attractive web of “pathologizing.” Experiences that heightened this awareness for the author are described, followed by illustration of the importance and benefit of therapists becoming more sensitive to the study of human resiliency.