Aspects of the Client's Conscious Control of the Psychotherapeutic Process

An analysis is made of the opening moments of dialogue between and a client and her therapist in the light of the client's commentary given during an Interpersonal Process Recall interview about the moments. These moments are drawn from a study of 14 clients' reports on their experiences of therapy, thus particularizing the general understanding derived in the larger project. This passage of dialogue was chosen because the client's commentary revealed that, in the brief space of time involved, she had exerted control in terms of the three main relationships as experienced by all clients in the larger study: the relationship with the self, the therapist, and the therapist's techniques. Such control is understood to be an expression of clients' reflexivity, defined as self-awareness and agency within that self-awareness. The understanding that there is an agential involvement in reflexivity is based on both the participants' reports and the author's examination of his own consciousness. The study is discussed in terms of clients' covert experience of therapy and ways of gaining greater access to the unspoken in order to facilitate the working alliance.     

The Role of Creativity in Marriage and Family Therapy Practice: A National Online Study

The purpose of this study, using an online methodology, was to investigate therapists' perceptions of the role of creativity in couples' and family therapy. Along with completing a quantitative measure assessing creativity in their work, participants responded to four open-ended questions which addressed the meaning of creativity, characteristics of a creative family therapist, some creative interventions they have used with couples and families, and barriers to their own creativity as a family therapist. A total of 142 marriage and family therapists in 36 states in the United States participated. The findings shed light on the unique importance of creativity in couples and family treatment.     

Rebuilding family relationship bridges

This paper describes two techniques that the family therapist can use to help families in emotional crisis change and heal. They require the family therapist to persuade family members to view the therapy sessions as a project in building or rebuilding their family relationship bridges. An essential component of these approaches is the value placed by the family therapist on building rather than destroying family relationship bridges. Four themes are suggested as building blocks for healing dysfunctional family relationships: Love, Anger, Loss and Forgiveness. Vignettes of several family problems are presented accompanied by an intervention demonstrating an aspect of family bridge building.     

Thinking and Working Relationally: Interviewing and Constructing Hypotheses to Create Compassionate Understanding

In the initial interviews of family therapy sessions, the therapist faces the challenge of obtaining and organizing the information that is most relevant toward understanding the essential concerns that families and couples bring to therapy. This article describes the process of clinical interviewing and case conceptualization used in training family therapists at the Ackerman Institute for the Family. This approach helps the therapist bring forward, and organize, specific information into relational hypotheses, or systemic‐relational conceptualizations, that allow both family members and the therapist to understand presenting problems within their relational contexts. While always provisional, relational hypotheses help anchor the therapist in a systemic‐relational frame and provide a conceptual through‐line to guide the ongoing work of the therapy. The process of interviewing and the construction of clear and complex conceptualizations of presenting problems are illustrated through case examples.     

Their home is their castle: learning to do in-home family therapy.

The client's home is emerging as a typical site in which family therapy is delivered, yet training programs tend to train students in an office-based model. This qualitative study examines the process that three student interns went through as they learned to do home-based therapy after having been trained in a clinic setting. All three found that the experience of working in the clients' homes challenged their beliefs about therapy as well as the models of a professional relationship; all reformulated their views on therapy because of this challenge. A model is proposed that describes the students' journey from being a clinic-based to becoming a home-based therapist.     

The Effect of Therapist–Client Racial Similarity on Client Satisfaction and Therapist Evaluation of Treatment

Client satisfaction with therapy services and therapists' perspectives of treatment evaluation were examined in relation to therapist and client racial similarity. Secondary data from a university marriage and family therapy clinic located in the southeast was used to pair therapists and clients on racial similarity or difference. Statistical analyses revealed no major differences in clients' perceptions of satisfaction based on similarity to therapists' race. Therapists indicated some differences in their perceptions of the success of services provided to clients based on similarity to client's race. Implications for researchers, clinicians, and educators are included.     

Better versus worse family therapy sessions as reflected in clients' alliance-related behavior

To be responsive to clients' evaluations of the unfolding therapy process, therapists must first accurately "read" client behavior, a particularly challenging task in conjoint family therapy. In this study, the authors compared client behavior in 28 sessions that one family member and the therapist concurred, on the Session Evaluation Questionnaire (W. B. Stiles & J. S. Snow, 1984), were relatively better or worse than their other sessions. Client behavior was rated from videotapes using the System for Observing Family Therapy Alliances (SOFTA-o; M. L. Friedlander et al., 2006). In contrast to the worse sessions, the better sessions were characterized by significantly greater client Engagement in the Therapeutic Process and Safety within the Therapeutic System. Notably, whereas only the worse sessions had exceptionally poor within-family collaboration, 40% of the better sessions were characterized by mild family conflict. Implications are discussed for building theory on therapist responsiveness and for future research that may benefit practice, training, and supervision.     

My family: my self

This paper arises from an experiential workshop presented at the Fifth AFT Annual Conference, the theme of which was the context in which family therapy is practised, including the psycho-social environment of the family therapist. Participants in the workshop were invited to look at themselves as a member of a family (not as professionals); to look at learning in their family of origin; to examine the impact of what and how they learned on their current psycho-social behaviour; to consider the implications of such learning patterns in relation to their clients; to recognize the potential of clients' learning abilities and skills to effect change.     

Long-term family therapy: A developmental approach

The emphasis in family therapy literature on brief therapy has given a false sense of what family therapy can accomplish. While it has helped to develop different theories of change and refine techniques to deal with resistance, it has caused many clinicians to mistake technique for treatment. A long term developmental approach is advocated in which the family therapist is the general practitioner rather than the specialist. This paper is the result of a 30-year caseload in which there was a group of multi-therapy families.     

Client and therapist variability in clients' perceptions of their therapists' multicultural competencies

This study examined therapist differences in their clients' ratings of their therapists' multicultural competencies (MCCs) as well as tested whether therapists' who were rated as exhibiting more MCCs also had clients who had better therapy outcomes (N = 143 clients and 31 therapists). All clients completed at least 3 sessions. Results demonstrated that therapists accounted for less than 1% of the variance in their clients' Cross-Cultural Counseling Inventory–Revised (CCCI-R; T. D. LaFromboise, H. L. K. Coleman, & A. Hernandez, 1991) scores, suggesting that therapists did not differ in terms of how clients rated their MCCs. Therapists accounted for approximately 8.5% of the variance in therapy outcomes. For each therapist, their clients' CCCI-R scores were aggregated to provide an estimate of therapists' MCCs. Therapists' MCCs, based on aggregate CCCI-R scores, did not account for the variability in therapy outcomes that were attributed to them. Additionally, clients' race/ethnicity, therapists' race/ethnicity, or the interaction of clients'–therapists' race/ethnicity were not significantly associated with clients' perceptions of their therapists' MCCs.     

Family Therapy for the Historian?— The Case of William James

Family therapists disagree over the utility of historical reconstruction for treatment. Following either a behavioral or a psychoanalytic paradigm, theorists insist that history is irrelevant or essential to the treatment process. This paper demonstrates how a variety of family therapy concepts were used in his historical research into the life of the family of William James, the American psychologist and philosopher (1842–1910). This is offered as evidence both that family theory has a contribution to make to the writing of history and that the historical process is important to family therapy. It is suggested that clinical actuality calls forth interventions within both paradigms, often by the same therapist with the same family. The alternatives need not be mutually exclusive, though theory-building is clarified by talking as if the therapist were confronted by an either/or choice.     

Fostering Client Creativity in Family Therapy: A Process Research Study

Creativity has been shown to enhance problem solving, and to increase flexibility and adaptability—qualities associated with positive therapeutic outcomes. Literature related to therapist and/or client creativity is primarily anecdotal. Empirical literature addressing how therapists can facilitate the creativity of their clients in family therapy is scarce. In this study, the researchers used process methodology to code the behavior of therapists and clients in 31 videotaped family therapy sessions. Results show a significant positive correlation between interventions that induce positive affect and the creative client behaviors of optimism and playfulness.     

Understanding alliances. How can research inform user‐friendly practice?

'User-friendliness' is described as a therapist stance which involves attentiveness to the quality of the 'therapeutic relationship', both between therapist and family and between service providers and their public. This article draws on research published in the last seven years from within and outside the family therapy field which can help improve this relationship. I will argue that the issues which challenge user-friendly practice need to be related to the theories which inform family therapy and to the traditional tension within the research field between focusing on measurable outcomes or on user satisfaction. The urgency for a clear analysis of what can make family therapy practice more sensitive to its public comes partly from the relative state of maturity which family therapy has now reached and its need actively to work alongside other approaches. Other crucial influences considered are a greater public demand for choice and improvements in public services, and social policy trends towards greater efficiency and accountability within the helping services.     

Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families

Client engagement is an essential yet challenging ingredient in effective therapy. Engaged clients are more likely to bond with therapists and counselors, endorse treatment goals, participate to a greater degree, remain in treatment longer, and report higher levels of satisfaction. This study explored the process of engaging high-risk youth and their parents in a unique home-based family therapy intervention. Qualitative interviews were conducted with 19 families who completed family therapy sessions that included a core component aimed at increasing treatment engagement. Parents’ and youths’ perceptions of engagement suggest the importance of developing therapeutic alliance with therapists, who facilitated building a shared alliance among family members. Implications for improving client engagement are discussed within the context of alliance building with the therapist and among family members.     

Indications for selecting family or individual therapy

Indications for either individual therapy or family therapy as treatments of first choice are identified at the initial family assessment.
A family approach is suggested in (1) scapegoating systems where the symptom is essential to the family homeostasis; (2) enmeshed families where communications are confused and diffuse; (3) paranoid-schizoid families where the family denies the symptoms and (4) families in a current acute shared crisis.
Individual treatment is indicated when (1) the patient has suffered traumatic separations; (2) separate help is asked for; (3) the therapist considers individuation necessary and (4) unusual life experience. Clinical examples are given.     

Experiential personal construct therapeutic artistry: The therapy relationship and the timing of interventions

Abstract

Experiential personal construct psychotherapy focuses on the intimate, interconnected, and evolving relationship between the therapist and the client as vital to therapeutic growth. Great creativity is demanded of the therapist who aspires to connect with clients in life‐changing psychotherapy. This article first describes the essential nature of the therapy relationship with its implicit and explicit demands for therapist creativity. These principles then are illustrated through a discussion of the critical issue of timing therapeutic interventions.     

Enlisting family support in drug treatment

Drug abuse programs often experience difficulties involving clients' families in treatment. This article describes general principles and specific techniques for recruiting family members in drug abuse programs and in other treatment settings. Stanton and Todd's principles of recruiting for family therapy in drug programs generally apply, adapted to a project that involves only one family member in multifamily groups and provides psychoeducational training rather than therapy. Additional principles include: focusing on family members who live with the client, tailoring recruitment to the needs of individual families, emphasizing how the family member will benefit, addressing resistance directly, helping families to build a support network, and informing family members of what is expected of them. The psychoeducational approach shows promise as a beneficial adjunct to client-focused treatment and as a gateway to more extensive family treatment.     

CREATIVITY IN EXPERIENTIAL PERSONAL CONSTRUCT PSYCHOTHERAPY

We propose that experiential personal construct psychotherapy demands therapist creativity in engaging clients, beginning with the initial diagnosis and continuing through the entire therapy process. We suggest a number of ways of enhancing therapist creativity in the therapy room. We discuss making time for aloneness, seeking particular kinds of interactions with others, fantasizing, having a passion for one's work, trying on roles, exposing oneself to literature and the arts, leading a balanced life, reducing time pressures, making judgments, focusing on process, and seeing client growth. Finally, we consider creativity in the life of the therapist beyond the therapy room. We explore how the therapist's desire to be a part of lifechanging psychotherapy mandates the personal pursuit of creativity.     

The integration of family therapy in a psychiatric day hospital

The clients, who present themselves at our psychiatric day hospital in Amsterdam, often have long-standing problems. These problems are usually of a complex nature, and the age of the clients plays an imporant role in this. Their age varies from seventeen to forty, with an average of twenty-eight.
Efforts were made over a long period to facilitate solutions to the clients' family conflicts. During this time an extensive range of problems within the family were presented of which the symptoms of the client represent just a part.
Working as a family therapist in a psychiatric day hospital, where clients are admitted individually, places the family therapist in a number of dilemmas, especially when many working in the hospital see the problems only as individual ones.