Brief strategic family therapy: lessons learned in efficacy research and challenges to blending research and practice

In this article, we present key lessons that we have learned from (1) a long program of research on an empirically supported treatment, brief strategic family therapy (BSFT), and (2) our ongoing research and training efforts related to transporting BSFT to the front lines of practice. After briefly presenting the rationale for working with the family when addressing behavior problems and substance abuse in adolescent populations, particularly among Hispanic adolescents, we summarize key findings from our 30-year program of research. The article closes by identifying barriers to the widespread adoption of empirically supported treatments and by presenting current work within the National Institute on Drug Abuse's Clinical Trials Network that attempts to address these barriers and obstacles.     

What Does It Mean to Be Relational? A Framework for Assessment and Practice

The authors begin with a question regarding how to better draw upon relational thinking in making case assessments and treatment plans. They first address issues regarding the cultural construction of self and relationships, integrating women's psychology, family systems, and collectivist culture literatures within a discussion of power. Then they present a heuristic framework for how individuals orient themselves within relationships that includes two dimensions--focus and power--and evolves out of the social context. From these two dimensions, a typology of four basic relational orientations is presented: position directed, rule directed, independence directed, and relationship directed. Case examples from couple's therapy and suggestions for practice are provided.     

DIMENSIONS OF FRUSTRATION INTOLERANCE AND THEIR RELATIONSHIP TO SELF-CONTROL PROBLEMS

Frustration intolerance beliefs are central to the theory and practice of Rational Emotive Behavior Therapy. However, there has been little investigation of the content of these beliefs, and empirical evidence linking specific beliefs to distinct psychological problems is sparse. To redress this, the Frustration–Discomfort Scale has been developed as a multidimensional measure. This was used to explore the relationship between the four dimensions of frustration intolerance (emotional intolerance, demands for entitlement, comfort, and achievement) and problems of self-control. Results indicated that the Frustration–Discomfort sub-scales showed differential relationships with self-control problems, independent of self-worth beliefs. This supported the validity and usefulness of the scale and the importance of distinguishing between dimensions of frustration intolerance. This paper is based on research submitted to the University of Edinburgh in part fulfillment of a Doctorate of Philosophy degree. Address correspondence to Neil Harrington, Psychology Department, Stratheden Hospital, Cupar, Fife, KY15 5RR, UK; e-mail: neil@nharr.freeserve.co.uk.     

IRRATIONAL BELIEFS AND SOCIAL CONSTRUCTIONISM: CORRELATIONS WITH ATTITUDES ABOUT REALITY,BELIEFS ABOUT PEOPLE,AND COLLECTIVE SELF-ESTEEM

Rational Emotive Behavior Therapy (REBT) is theoretically consistent with the postmodern social constructionist assumption of a reciprocal causality between the individual and society. In a test of this claim, REBT irrationalities as measured by the Irrational Belief Scale and by the Survey of Personal Beliefs were correlated with Attitudes toward Reality, Cynicism, Beliefs in the Conventional Goodness of People, and Collective Self-Esteem. All measures of irrationality identified the postmodern social constructionism recorded by the Attitudes toward Reality Scale as rational. Especially the Irrational Belief Scale identified Cynicism and Beliefs in the Conventional Goodness of People as irrational and Collective Self-Esteem as rational. The Survey of Personal Beliefs described Collective Self-Esteem as irrational and therefore suggested that the conceptual framework of REBT can promote negative assessments of collectivistic forms of adjustment. Most importantly, however, these data confirmed that REBT includes potentials that are compatible with postmodern social constructionism. Address correspondence to P. J. Watson, Psychology/Department # 2803, University of Tennessee at Chattanooga, 350 Holt Hall-615 McCallie Ave, Chattanooga, TN 37403, USA; e-mail: paul-watson@utc.edu     

一例使用态度治疗对大学新毕业生神经衰弱的案例报告

大学新毕业生工作适应不良是常见的现象,也是目前大学生就业担忧和顾虑的问题之一。这位刚毕业进入工作岗位的求助者出现了明显的抑郁症状,且在咨询过程中发现其抑郁的根源可以追溯到童年时期,并且有深刻的家庭教育文化背景。诊断为神经衰弱,采用态度治疗和心理稳定化技术后,经过两个月的咨询,求助者的神经衰弱症状基本消失,对自己和未来的态度基本明朗。一个月后电话回访,显示咨询效果良好。     

A Dyadic Analysis of the Between‐ and Within‐System Alliances on Distress

To read this article's abstract in both Spanish and Mandarin Chinese, please visit the article's full‐text page on Wiley InterScience ( http://interscience.wiley.com/journal/famp ). This study examines the relationship between the therapeutic alliance and distress using the couple rather than the individual as the unit of analysis. One hundred and seventy‐three couples receiving treatment for relational distress at two university clinics participated in this study. The actor–partner interdependence model was used to analyze the relationship of each partner's between‐ and within‐system alliance scores and distress at session four. Results provide support for actor effects on relational distress for both male and female partners and for actor effects on psychological distress for female partners. Limited support was found for partner effects on distress. Furthermore, results indicate that the alliance between partners is a stronger predictor of improvement in early sessions in comparison with the alliance between the individual and the therapist.     

The efficacy of systemic therapy with adult patients: a meta-content analysis of 38 randomized controlled trials

Systemic therapy is a widely used psychotherapy approach. Yet there exist few systematic reviews on its efficacy. A meta-content analysis was performed to analyze the efficacy of systemic therapy for the treatment of mental disorders in adulthood. All randomized (or matched) controlled trials (RCT) evaluating systemic/systems oriented therapy in various settings (family, couple, individual, group, multifamily group therapy) with adult index patients suffering from mental disorders were identified by database searches and cross-references in other reviews. Inclusion criteria were: index patient diagnosed with a DSM or ICD listed mental disorder, trial published in any language up to the end of 2008. The RCTs were content analyzed according to their research methodology, interventions applied, and results. Thirty-eight trials published in English, German, Spanish, and Chinese were identified, 34 of them showing systemic therapy to be efficacious for the treatment of mood disorders, eating disorders, substance use disorders, mental and social factors related to medical conditions and physical disorders, and schizophrenia. Systemic therapy may also be efficacious for anxiety disorders. Results were stable across follow-up periods of up to 5 years. There is a sound evidence-base for the efficacy of systemic therapy for adult index patients with mental disorders in at least five diagnostic groups.     

Love in Action: An Integrative Approach to Last Chance Couple Therapy

This article presents an integrative approach to the special challenges of therapy with couples on the brink of dissolution or divorce—who often describe this therapy as their “last chance.” In some, one partner is considering ending the relationship, and in others, both partners are considering ending it. Often, these couples have had prior dissatisfying experiences in couple therapy. Four types of last chance couples are described: high‐conflict couples; couples in which partners have differing goals for their lives or different timelines for reaching shared goals; couples in which one or both partners have acted in a manner that violates the values, expectations, emotional comfort, or safety of the other; and couples in which there has been a gradual loss of intimacy. The Therapeutic Palette, a multiperspectival, theoretically eclectic integrative approach, is enlisted as a general framework for selecting and sequencing use of particular theories and their associated practices, based on the three “primary colors” of couple therapy: time frame/focus, level of directiveness, and change entry point. An additional complementary framework, the creative relational movement approach, is proposed to provide an integrative frame encompassing both language‐based and action‐based practices, suggesting that meaning is held and expressed as much through interaction or “relational motion” as it is through language. Principles of change are described. Due to the couple's level of crisis and desire for immediate evidence of possible improvement, priority is given to action‐based interventions in early stages of therapy, by engaging couples in “experiments in possibility.” Typical action approaches are described. An extended vignette follows.     

Principle‐Based Integrative Therapy with Couples: Theory and a Case Example

The Principle‐Based Integrative Therapy (PBIT) framework harnesses the principles of change underlying each theoretical model within integrative couple therapy treatments. PBIT has commonalities with other integrative approaches, and additional advantages stemming from its four tenets that guide therapists in combining strengths across models and overcoming each of their deficiencies. Tenet 1 advises that each model adds a core principle or mechanism of action that other models do not automatically address. Tenet 2 focuses on how techniques of one model may actualize the principles of other models. Tenet 3 ensures complementarity and a lack of conflict across principles. A case study and common case considerations are presented to illustrate how Tenets 1–3 can work in integrating Cognitive‐Behavioral, Multicultural, and Emotionally Focused Therapy models in working with a couple. Finally, Tenet 4 advocates for the use of models and empirically supported principles that also have received empirical support with diverse populations. Prerequisites and training implications for PBIT, and future clinical and research directions to further the utility of PBIT are discussed.     

What Does it Mean to be a Common Factors Informed Family Therapist?

The common factors paradigm in couple and family therapy has gained popularity over the past several decades, leading many therapists to refer to themselves as common factors family therapists. Despite this, no consensus exists on what it means to be a common factors family therapist, or if such a designation even makes sense given that the common factors paradigm is not a model. Synthesizing the existing common factors literature, a case is made for the designation “common factors informed family therapist,” and the following six core principles are outlined that characterize this designation: (1) sees overlap among theories; (2) passionate about theory, not a theory; (3) client centered; (4) monitors hope and the therapeutic alliance; (5) views clients as people rather than objects; and (6) prioritizes healing over therapy. Each of the concepts is discussed in depth, and clinical implications are provided.