Small Acts of Living: Everyday Resistance to Violence and Other Forms of Oppression

The author describes an approach to therapy which is based on the observation that whenever persons are badly treated, they resist. Case illustrations are given in which individuals seeking therapy had been subjected to violence and oppression.     

Solution-Focused Therapy in Prison

This is a report on a combined therapy and research project conducted with a seriously criminal population in Swedish prisons and using a Solution-Focused Brief Therapy approach with a focus on networks. Recidivism was significantly lower and less serious among experimental group participants. A case study is included.     

Tasteful Solutions: Solution-Focused Work with Groups of Immigrants

Solution-focused family therapy is well established as a method in the therapeutic field. Less is written regarding solution-focused thinking and practice in preventive work, providing health information. Informed by the work of Insoo Kim Berg and Steve de Shazer, a workshop of primary health care was established in an inner city area of Oslo, Norway in 1994 with a major task of developing methods for providing information about health issues for immigrants as well as the native population. Results from an evaluation of this work are presented and some issues are related to empowerment work and especially Paulo Freires' liberating dialogue.     

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.     

Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: pilot results

Cognitive behavior therapy (CBT) has been demonstrated in a number of randomized controlled trials to be efficacious as an adjunctive treatment for psychotic disorders. Emerging evidence suggests the usefulness of CBT interventions that incorporate acceptance/mindfulness-based approaches for this population. The current study extended previous research by Bach and Hayes (2002. The use of Acceptance and Commitment Therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70, 1129-1139) using Acceptance and Commitment Therapy (ACT) in the treatment of psychosis. Psychiatric inpatients with psychotic symptoms were randomly assigned to enhanced treatment as usual (ETAU) or ETAU plus individual sessions of ACT. At discharge from the hospital, results suggested short-term advantages in the ACT group in affective symptoms, overall improvement, social impairment, and distress associated with hallucinations. In addition, more participants in the ACT condition reached clinically significant symptom improvement at discharge. Although 4-month rehospitalization rates were lower in the ACT group, these differences did not reach statistical significance. Decreases in the believability of hallucinations during treatment were observed only in the ACT condition, and change in believability was strongly associated with change in distress after controlling for change in the frequency of hallucinations. Results are interpreted as largely consistent with the findings of Bach and Hayes and warrant further investigations with larger samples.     

On wisdom

This article explores some of the features involved in making wise decisions in couples and family therapy. Delineating what qualities are involved in making wise decisions in life--so as to live the "good life" in the polis, and the necessary contributions of life experiences in this task--was first discussed by Aristotle. A major problem that therapists face today is that our society offers many different ways of living well--or for that matter, badly--and our theories do the same. Family therapy theories are not value free. I clarify that different family theories embody different values: clear boundaries, good attachments, the ability to communicate, and so on. If our theories foster certain values, then, as Isaiah Berlin has made clear, seeking to achieve a particular value leads to placing less value on another. The article concludes with some thoughts about values that therapists could appropriately follow in their work.     

CAN RATIONAL-EMOTIVE BEHAVIOR THERAPY (REBT) AND ACCEPTANCE AND COMMITMENT THERAPY (ACT) RESOLVE THEIR DIFFERENCES AND BE INTEGRATED?

Rational-Emotive Behavior Therapy (REBT) is a pioneering form of Cognitive Behavior Therapy (CBT). Acceptance and Commitment Therapy (ACT) is part of the new wave of CBTs. In this article, I discuss the papers of Ciarrochi, Robb, and Godsell, and of Ciarrochi and Robb, who propose that REBT and ACT can be quite suitably integrated, and the paper of Steven Hayes, the originator of ACT and of Relational Frame Theory, who is skeptical about the feasibility of Ciarrochi, Robb, and Godsell’s proposals. My own view is that ACT and REBT significantly overlap in their theory and practice and that they can be successfully integrated if both therapies make some changes.     

Reshaping Couple Configurations that Get in the Way of Relationship Repair and Healing

In the context of relationship trauma, partners' reactive patterns of engagement can disrupt and derail attempts at relationship correction and healing. A circumplex typology of couple patterns of engagement in relational trauma context is defined in terms of partners' underlying views of self in relation to other (VSIRO). VSIRO is conceptualized along a continuum anchored at opposite poles by inflated (self-aggrandizing) versus collapsed (self-abnegating) VSIRO, with a balanced (egalitarian) VSIRO, characterized by accountability and forbearance, as the target position. The circumplex model delineates four problematic couple configurations—a dejected couple, a taker–enabler couple, an ultimate fighting couple, and a debtor–collector couple. Where problematic engagement occurs, therapists need to reshape couple engagement toward the balanced, egalitarian position prior to relational trauma work. Clinical vignettes depict these couples and springboard an analysis of unique needs and interventions associated with each couple configuration. Reshaping couple patterns of engagement using a circumplex model of couple configurations is an essential prerequisite to effective and ethical relational trauma work.     

The Impact of Treatment Components Suggested by the Psychological Flexibility Model: A Meta-Analysis of Laboratory-Based Component Studies

An important aspect of psychotherapy research is the examination of the theoretical models underlying intervention approaches. Laboratory-based component research is one useful methodology for this endeavor as it provides an experimental means of testing questions related to intervention components and the change process they engage with a high level of control and precision. A meta-analysis was conducted of 66 laboratory-based component studies evaluating treatment elements and processes that are suggested by the psychological flexibility model that underlies Acceptance and Commitment Therapy (acceptance, defusion, self as context, committed action, values, and present moment), but also touches on a variety of contextual forms of cognitive behavior therapy. Significant positive effect sizes were observed for acceptance, defusion, present moment, values, mixed mindfulness components, and values plus mindfulness component conditions compared to inactive comparison conditions. Additional analyses provided further support for the psychological flexibility model, finding larger effect sizes for theoretically specified outcomes, expected differences between theoretically distinct interventions, and larger effect sizes for component conditions that included experiential methods (e.g., metaphors, exercises) than those with a rationale alone. Effect sizes did not differ between at-risk/distressed and convenience samples. Limitations with the meta-analysis and future directions for laboratory-based component research are discussed.