A Critical Methodological Review of Discourse and Conversation Analysis Studies of Family Therapy

Discourse (DA) and conversation (CA) analysis, two qualitative research methods, have been recently suggested as potentially promising for the study of family therapy due to common epistemological adherences and their potential for an in situ study of therapeutic dialog. However, to date, there is no systematic methodological review of the few existing DA and CA studies of family therapy. This study aims at addressing this lack by critically reviewing published DA and CA studies of family therapy on methodological grounds. Twenty‐eight articles in total are reviewed in relation to certain methodological axes identified in the relevant literature. These include choice of method, framing of research question(s), data/sampling, type of analysis, epistemological perspective, content/type of knowledge claims, and attendance to criteria for good quality practice. It is argued that the reviewed studies show “glimpses” of the methods’ potential for family therapy research despite the identification of certain “shortcomings” regarding their methodological rigor. These include unclearly framed research questions and the predominance of case study designs. They also include inconsistencies between choice of method, stated or unstated epistemological orientations and knowledge claims, and limited attendance to criteria for good quality practice. In conclusion, it is argued that DA and CA can add to the existing quantitative and qualitative methods for family therapy research. They can both offer unique ways for a detailed study of the actual therapeutic dialog, provided that future attempts strive for a methodologically rigorous practice and against their uncritical deployment.     

The Efficacy of Systemic Therapy for Childhood and Adolescent Externalizing Disorders: A Systematic Review of 47 RCT

Systemic (family) therapy is a widely used psychotherapy approach. However, most systematic efficacy reviews have focused solely on “family‐based treatment” rather than on the theoretic orientation “systemic therapy.” We systematically review trials on the efficacy of systemic therapy for the treatment of childhood and adolescent externalizing disorders. All randomized (or matched) controlled trials (RCT) evaluating systemic/systems‐oriented therapy in various forms (family, individual, group, multi‐family group therapy) with child or adolescent index patients (0–17 years) suffering from mental disorders were identified by data base searches and cross‐references. Inclusion criteria were as follows: index patient diagnosed with a DSM‐ or ICD‐listed mental disorder, and trial published in any language up to the end of 2011. The RCTs were analyzed for their research methodology, interventions applied, and results (postintervention; follow‐up). A total of 47 trials from the United States, Europe, and China, published in English, German, and Mandarin, were identified. A total of 42 of them showed systemic therapy to be efficacious for the treatment of attention deficit hyperactivity disorders, conduct disorders, and substance use disorders. Results were stable across follow‐up periods of up to 14 years. There is a sound evidence base for the efficacy of systemic therapy for children and adolescents (and their families) diagnosed with externalizing disorders.     

An Activities Approach to the Treatment of Mentally Retarded Clients in an Acute Care Psychiatric Hospital

This article describes therapeutic activities offered in an occupational therapy treatment program for mentally retarded patients in an acute-care hospital facility. Implications of therapeutic activities for the building of ego strengths are discussed.     

Telephone-Administered Cognitive Behavior Therapy for Obsessive-Compulsive Disorder

Exposure with response prevention and cognitive behavior therapy are widely recognized as effective treatments for obsessive-compulsive disorder. Unfortunately, many people with obsessive-compulsive disorder - particularly those living in rural areas - do not have access to therapists providing these treatments. Accordingly, we investigated the efficacy of telephone-administered cognitive behavior therapy for obsessive-compulsive disorder. Two open trials are reported, for a total of 33 people with obsessive-compulsive disorder (without major depression). The first trial consisted of 12 weeks on a waiting list followed by 12 weeks of treatment (delayed treatment). The second trial consisted of 12 weeks of immediate treatment. Obsessive-compulsive symptoms did not change during the waiting period. Symptoms declined from pre- to post-treatment, with gains maintained at 12-week follow-up. For the pooled sample our pre-to-post-treatment effect size was as large or larger than those obtained in other studies of reduced contact treatment, and similar to those of face-to-face exposure with response prevention. Our proportion of treatment dropouts tended to be lower than those of other reduced contact interventions. The results suggest that telephone-administered cognitive behavior therapy is effective and well-tolerated, at least for people with obsessive-compulsive disorder without major depression. It remains to be seen whether this treatment is safe and effective when comorbid major depression is present.     

Dietary Control of Rumination: Two Case Studies

Chronic rumination of 2 institutionalized men with profound mental retardation was treated using a dietary approach. In the first case, a peanut butter or honey supplement was given, whereby 2 spoonfuls of either food was added to every meal, with drinks moved to a later time. In the second case, food satiation together with a honey supplement was applied. In the first case, an ABABACA design was used. In the second case, the non-experimental AB design was applied. In both cases, rapid decrease in rumination was achieved. Anecdotal follow-up confirmed the permanency of the results.     

The Use of a Child-Based Acceptance and Commitment Therapy Curriculum to Increase Attention

Acceptance and Commitment Therapy (ACT) is a treatment that integrates mindfulness and acceptance training with behavior change processes. One of the core processes in ACT is contact with the present moment which involves shifting attention to what is happening here and now, contacting both internal and external stimuli. An experimental and control group were used to determine the impact ACT had on attention. ACT participants (M?=?5.4, SD?=?9.8) showed fewer inaccuracies on the CPT-X task compared to the control group (M?=?19.75, SD?=?16.1) at posttest F(1, 38)?=?11.49, p?=?.02, ηp²?=?.232. Results of the current study demonstrate participation in the use of an ACT curriculum for children to help increase attention outcomes.     

Guidelines for classifying evidence-based treatments in couple and family therapy

Guidelines for Evidence-Based Treatments in Family Therapy are intended to help guide clinicians, researchers, and policy makers in identifying specific clinical interventions and treatment programs for couples and families that have scientifically based evidence to support their efficacy. In contrast to criteria, which simply identify treatments that "work" and have been employed in the evaluation of other psychotherapies, these guidelines propose a three-tiered levels-of-evidence-based model that moves from "evidence-informed," to "evidence-based," to "evidence-based and ready for dissemination and transportation within diverse community settings." Each level reflects an interaction between the specificity of the intervention, the strength and readth of the outcomes, and the quality of the studies that form the evidence. These guidelines uniquely promote a clinically based "matrix" approach in which the empirical support is evaluated according to various dimensions including strength of the outcomes, the applicability across cultural contexts, and demonstration of specific change mechanisms. The guidelines are offered not only as a basis for understanding the evidence for diverse clinical approaches in couple and family therapy within the systemic tradition of the field, but also as an alternative aspirational model for evaluating all psychotherapies.     

Facilitating relational empowerment in couple therapy

Couples in distressed relationships often get caught up in power struggles, "Power Over" interactions that are informed by both neurobiology (e.g., the fight-flight reaction) and by cultural assumptions (e.g., competition, individualism, and patriarchy). This article seeks to widen the discourse about power by highlighting "Power To" and "Power With." Power To includes the ability to self-regulate, to read and manage one's own emotions, and to have voice while respecting the other's voice. Power With reflects the couple's commitment to conurture the relationship through empathy, respect, and generosity. Power To and Power With are proposed to constitute relational empowerment, the ability to navigate one's inner world and the interpersonal realm. The neurobiology of both couples' reactivity and relational empowerment are considered. Techniques are offered to facilitate Power To and Power With, interventions that interrupt couples' cycles of reactivity and allow them to make more thoughtful choices. Emotion regulation and empathy are particularly important skills of relational empowerment, and examples are offered to increase these capacities in couple therapy. The therapeutic perspective offered in this article challenges cultural practices and assumptions that keep intimate partners polarized in power struggles, and explores how relational empowerment can foster an egalitarian, mutually respectful relationship.     

Channels of Change: Contrasting Network Mechanisms in the Use of Interventions

This study informs community science, and seeks to narrow the research-to-practice gap, by examining how the interpersonal networks within a setting influence individuals' use of interventions. More specifically, it explores the role of two network mechanisms-cohesion and structural similarity-in urban elementary school teachers' use of interventions designed to improve academic and behavioral outcomes for students. Lagged regression models examine how position in advice giving networks influenced weekly use of the daily report card and peer assisted learning by kindergarten through fourth grade teachers in three schools. Results indicate that intervention use spreads among teachers with similar patterns of advice-giving relationships (i.e., via structural similarity), rather than from teachers who are sources of advice (i.e., via cohesion). These results are consistent with findings in other settings, and suggest that researchers wishing to increase the use of an intervention should select change agents based on their patterns of their relationships, rather than on their direct connections.     

Developing the therapeutic relationship: from 'expert' professional to 'expert' person who stutters

This article looks back over the years and identifies some of the most influential thinkers, writers, and researchers who have had a profound effect on the way the therapy at the Michael Palin Centre for Stammering Children in London has evolved. It tracks the changes that have occurred in theoretical perspective, treatments offered, and the delivery of therapy. In particular this author is interested in the changing nature of the therapeutic relationship between professionals and people who stutter (PWS), and describes the way it has developed from the “expert professional” towards a more collaborative relationship that recognises the “expert patient”. It was inspired by a book written in 1902 by Mr Beasley, a person who stammered. After several unsuccessful attempts to find a ‘cure’ he found his own solution to his stuttering and then used what he had learned to help many others. Much of what he wrote was well ahead of his time and reminds us, the professionals, of the importance of listening to and taking account of the views of PWS in therapy and designing treatment that meets the needs of the individual. This article also looks briefly at evidence based practice (EBP) and the issues involved in measuring outcomes that reflect the complex and individual nature of the problem. Finally the importance of the research in developing the knowledge and skill base of clinicians as well as PWS is acknowledged and discussed and the way ahead signposted.Educational objectives: The reader will learn about (1) the early history and development of stuttering therapy, (2) the influence of a variety of psychotherapeutic approaches, (3) the relevance of designing therapy to meet the needs of the PWS, and (4) discuss the role of ‘common’ factors in EBP.