Distilling Common History and Practice Elements to Inform Dissemination: Hanf-Model BPT Programs as an Example

There is a shift in evidence-based practice toward an understanding of the treatment elements that characterize empirically supported interventions in general and the core components of specific approaches in particular. The evidence base for behavioral parent training (BPT) and the standard of care for early-onset disruptive behavior disorders (oppositional defiant disorder and conduct disorder), which frequently co-occur with attention deficit hyperactivity disorder, are well established, yet an ahistorical, program-specific lens tells little regarding how leaders, University of Oregon Medical School, shaped the common practice elements of contemporary evidence-based BPT. Accordingly, this review summarizes the formative work of Hanf, as well as the core elements, evolution, and extensions of her work, represented in Community Parent Education (COPE; (Cunningham et al. in J Child Psychol Psychiatry 36:1141–1159, 1995; Cunningham et al. in COPE, the community parent education program: large group community-based workshops for parents of 3- to 18-year-olds, COPE Works, Hamilton, 2009), Defiant Children (DC; (Barkley in Defiant children: a clinician’s manual for assessment and parent training, Guilford Press, New York, 1987; Barkley in Defiant children: a clinician’s manual for assessment and parent training, Guilford Press, New York, 2013), Helping the Noncompliant Child (HNC; Forehand and McMahon in Helping the noncompliant child: a clinician’s guide to parent training, Guilford Press, New York, 1981; McMahon and Forehand in Helping the noncompliant child: family-based treatment for oppositional behavior, 2nd ed., Guilford Press, New York, 2003), Parent–child interaction therapy (PCIT; Eyberg and Robinson in J Clin Child Adolesc Psychol 11:130–137, 1982. doi:10.1080/15374418209533076; Eyberg in Child Fam Behav Ther 10:33–46, 1988; Eyberg and Funderburk in Parent–child interaction therapy protocol, PCIT International, Gainesville, 2011), and the Incredible Years (IY; (Webster-Stratton in Behav Ther 12:634–642, 1981. doi:10.1016/S0005-7894(81)80135-9; Webster-Stratton in J Pediatr Psychol 7:279–294, 1982. doi:10.1093/jpepsy/7.3.279; Webster-Stratton in The incredible years: parents and children series. Leader’s guide: preschool version of BASIC (ages 3–6 years, The Incredible Years, Seattle, 2008). Our goal is not to provide an exhaustive review of the evidence base for the Hanf-Model programs, rather our intention is to provide a template of sorts from which agencies and clinicians can make informed choices about how and why they are using one program versus another, as well as how to make inform flexible use one program or combination of practice elements across programs, to best meet the needs of child clients and their families. Clinical implications and directions for future work are discussed.     

Black Church Leaders’ Attitudes About Mental Health Services: Role of Racial Discrimination

Black church leaders are often first responders to mental health issues in the Black community, yet few researchers have examined their attitudes about seeking outside mental health services. In order to fill this gap, we surveyed 112 church leaders in a northeastern urban Baptist Black mega-church (22 associate pastors, 34 deacons, and 56 congregation care givers) using The National Survey of American Life. Findings suggest church leaders more often relied on the church community and alternative health services, leaders who attended church more often tended to report not receiving any outside mental health treatment, the closer church leaders felt to all Black people, the less satisfied they were with help received from formal mental health services, and leaders who experienced more racial discrimination tended to report worse overall mental and physical health. Clinical providers and Black churches should develop collaborative partnerships to better meet the needs of this community.     

Readiness for Change: Involving the Family with Adolescents in Residential Settings

Adolescence is a pivotal time in human development and can be a challenging time for individuals to learn to regulate emotions, while also balancing biopsychosocial changes. The family plays a key role in an adolescent’s development. Thus, it is imperative for families to remain involved when adolescents are in residential treatment for emotional or behavioral issues. In this paper, we explore the benefits of, and methods for, increasing the identified patient’s (i.e., the adolescent’s) and the family’s readiness for change. The process of increasing family engagement in residential treatment is considered through the lens of the Stages of Change model. Barriers practitioners may face with adolescents and their families are also addressed.     

Common Factors Come Alive: Practical Strategies for Implementing Common Factors in MFT Training

Presently, MFT training programs teach MFT models in a way that emphasizes differences over similarities (Karam et al. in J Marital Fam Ther, 2015. doi: 10.1111/jmft.12096; Sprenkle and Blow in J Marital Fam Ther 30:113–129, 2004a. doi: 10.1111/j.1752-0606.2004.tb01228.x, in J Marital Fam Ther 30:151–157, b. doi: 10.1111/j.1752-0606.2004.tb01230.x; Sprenkle et al. in Common factors in couple and family therapy: the overlooked foundation for effective practice. Guilford Press, New York, 2009). Although teaching a variety of models and their distinctiveness is vital, doing so may create a competitive rather than integrative relationship between models (Karam et al. 2015). While Karam et al. 2015 encourage the inclusion of common factors in MFT training, we expand their justification for the importance of doing so We also explain conceptual and practical ways to include common factors in MFT training. Common factors instruction can fulfill multiple purposes: (a) create a sense of cohesiveness for programs which need to teach breadth of topics that can seem unrelated, (b) help prepare practitioners who need to learn many models well but will likely adopt an integrative approach, (c) align with basic skills training, (d) align with process research, and (e) enhance the richness of individual models. For each of these purposes, we provide an example of a classroom activity. We conclude with a unifying example of how one student may learn the common-factors perspective and weave it into her reflective practices as an MFT student.     

Family Therapy for an Adult Child Experiencing Bullying and Game Addiction: An Application of Bowenian and MRI Theories

Bowenian theory and MRI family therapy model were chosen to treat a Korean male adult client whose symptomatic problems were bullying and game addiction. To test its validity of therapeutic effectiveness, the following case analysis methods were used: narrative analysis of interview contents, categorization of the nine sessions of verbatim, videotaping, and notes according to classified concepts (i.e., triangulation), and explanation using matrix and network. Results showed that low level of differentiation, patterns of emotional cutoff, and dynamics of triangulation were clearly present in this client. After MRI family therapy, changes were evident in perceptive references, communication patterns, stress-coping mechanism, symptomatic behaviors, and intra-family relationships.     

Expectations About Couple Therapy Over Time

One common factor of therapy, expectations, has been demonstrated to be a significant contributor to outcome in individual therapy. Despite this, little is known about expectations about couple therapy. This paper presents the qualitative results of a study exploring clients’ expectations before beginning couple therapy and after six sessions. Results indicate that clients form pre-therapy expectations about their therapist, the process of therapy, and their partner. Results also showed that after six sessions, clients’ expectations about therapy were often met or modified in ways that were positive. Implications for therapists and researchers are included.     

Equality in Education – Why We Must Go All the Way

In this paper I present and defend a highly demanding principle of justice in education that has not been seriously discussed thus far. According to the suggested approach, “all the way equality”, justice in education requires nothing short of equal educational outcome between all individual students. This means not merely between equally able children, or between children from different groups and classes, but rather between all children, regardless of social background, race, sex and ability. This approach may seem implausible at first, due to the far-reaching implications it entails, primarily its requirement to deny better-off children their advantage for the sake of equality. However the paper argues that all-the-way-equality, in fact, does a better job realizing the goals of justice in education than alternative conceptions of justice. It is further argued that at least some of the principle’s most radical consequences, those that make it seem counterintuitive, can be mitigated by balancing all-the-way-equality with competing interests.     

The Ladder of Rationality

This paper is a review and critical discussion of John Broome’s Rationality Through Reasoning. In particular, it engages critically with (i) Broome’s view on the independence of normative reasons and rationality, (ii) his construal of the capacity, property, and requirement senses of “rationality”, and (iii) his account of reasoning as a conscious, rule-following operation on mental contents.