Developing an outcome-based assessment for family therapy training: the Rochester Objective Structured Clinical Evaluation (ROSCE)

This paper addresses a growing need for cost-effective, outcome-based assessment in family therapy training. We describe the ROSCE, a structured, evidence-informed, learner-centered approach to the assessment of clinical skills developed at the University of Rochester Medical Center. The ROSCE emphasizes direct observation of trainees demonstrating clinical competencies. The format integrates both formative and summative assessment methods. It can readily be adapted to a wide variety of educational and training settings.     

The influence of an online auction's product price and e-retailer reputation on consumers' perception, attitude, and behavioral intention

Online auctions combine the conventional auction model with information technology. However, information asymmetry within such auctions causes risks and uncertainties that influence consumer purchase intentions. In this study, a 2 (product price: high vs. low) × 2 (e-retailer reputation: high vs. low) experimental design was used to understand whether the product price and e-retailer reputation will influence consumers' perceived risk, attitude toward the website and purchase intention. The results of this study indicate that perceived risk negatively influences consumer attitude toward the website and online purchase intention, while consumer attitude toward the website positively influences purchase intention. Moreover, involvement moderates the influence of product price and e-retailer reputation only on social risk but does not have a significant effect on consumer attitude toward the website. This study contributes to a more comprehensive understanding of online auction users' behavior. Finally, the managerial implications, limitations and future research directions are also provided.     

Parents' Differential Treatment of Adolescent Siblings in African American Families

Research on European and European American families suggests that parents' differential treatment of siblings has negative implications for youths' adjustment, but few studies have explored these dynamics in minority samples. This study examined parents' differential acceptance and conflict in a sample of mothers, fathers, and two adolescent siblings in 179 African American families who were interviewed on three annual occasions. In an effort to replicate findings from European and European American samples, we assessed the longitudinal associations between differential treatment and adolescent adjustment and tested three sibling characteristics (birth order, gender, and dyad gender composition) as potential moderators of these linkages. To illuminate the sociocultural context of differential treatment and its implications, we also explored parents' cultural socialization practices and experiences of financial stress as potential moderators of these links. Multilevel models revealed that, controlling for average parent–child relationship qualities, decreases in parental acceptance and increases in parent–youth conflict over time—relative to the sibling—were associated with increases in youths' risky behavior and depressive symptoms. Links between differential treatment and adjustment were not evident, however, when mothers engaged in high levels of cultural socialization and in families under high financial stress. The discussion highlights the significance of sociocultural factors in family dynamics.     

From Couple Therapy 1.0 to a Comprehensive Model: A Roadmap for Sequencing and Integrating Systemic,Psychodynamic, and Behavioral Approaches in Couple Therapy

Couple therapy is a complex undertaking that proceeds best by integrating various schools of thought. Grounded in an in‐depth review of the clinical and research literature, and drawing on the author's 40‐plus years of experience, this paper presents a comprehensive, flexible, and user‐friendly roadmap for conducting couple therapy. It begins by describing “Couple Therapy 1.0,” the basic conjoint couple therapy format in which partners talk to each other with the help of the therapist. After noting the limitations of this model, the paper introduces upgrades derived from systemic, psychodynamic, and behavioral/educational approaches, and shows how to combine and sequence them. The most important upgrade is the early focus on the couple's negative interaction cycle, which causes them pain and impedes their ability to address it. Using a clinical case example, the paper shows how all three approaches can improve couple process as a prerequisite for better problem solving. Additional modules and sequencing choice points are also discussed, including discernment counseling and encouraging positive couple experiences.     

A Multi‐Family Group Intervention for Adolescent Depression: The BEST MOOD Program

Depression is the most common mental disorder for young people, and it is associated with educational underachievement, self‐harm, and suicidality. Current psychological therapies for adolescent depression are usually focused only on individual‐level change and often neglect family or contextual influences. The efficacy of interventions may be enhanced with a broader therapeutic focus on family factors such as communication, conflict, support, and cohesion. This article describes a structured multi‐family group approach to the treatment of adolescent depression: Behaviour Exchange Systems Therapy for adolescent depression (BEST MOOD). BEST MOOD is a manualized intervention that is designed to address both individual and family factors in the treatment of adolescent depression. BEST MOOD adopts a family systems approach that also incorporates psychoeducation and elements of attachment theories. The program consists of eight multifamily group therapy sessions delivered over 2 hours per week, where parents attend the first four sessions and young people and siblings join from week 5. The program design is specifically aimed to engage youth who are initially resistant to treatment and to optimize youth and family mental health outcomes. This article presents an overview of the theoretical model, session content, and evaluations to date, and provides a case study to illustrate the approach.     

The Effectiveness of Functional Family Therapy for Adolescent Behavioral and Substance Misuse Problems: A Meta‐Analysis

A systematic review of published and unpublished English language articles identified 14 studies containing 18 comparisons between functional family therapy (FFT) and another condition in the treatment of adolescent disruptive behavior and substance use disorders. In 11 of these comparisons, assignment to conditions was random, while nonrandom assignment occurred in seven studies. For both random and nonrandom comparisons, separate meta‐analyses were conducted for subgroups of studies depending on the type of comparison group used. Data from studies of untreated control groups (CTL), treatment as usual (TAU), and well‐defined alternative treatments (ALTs) were analyzed separately. Effect sizes from these six meta‐analyses were as follows: random assignment FFT versus CTL (k = 3, d = 0.48, p < .01); random assignment FFT versus TAU (k = 3, d = .20, ns); random assignment FFT versus ALT (k = 5, d = .35, p < .05); nonrandom assignment FFT versus CTL (k = 2, d = .90, ns); nonrandom assignment FFT versus TAU (k = 2, d = .08, ns); and nonrandom assignment FFT versus ALT (k = 3, d = .75, p < .001). These results provide support for the effectiveness of FFT compared with untreated controls and well‐defined ALTs, such as cognitive behavior therapy, other models of family therapy, and individual and group therapy for adolescents.     

The Meta Marriage: Links Between Older Couples' Relationship Narratives and Marital Satisfaction

Drawing upon a relatively understudied population and a unique observational task, the current study sought to examine how older couples' interactional behaviors during a relationship narrative task were associated with marital satisfaction over time. Using observational data from a sample of 64 older, higher‐functioning married couples, we analyzed a series of Actor–Partner Independence Models (APIM) to explore how couples' interactional behaviors during a relationship narrative task were associated with spouses' marital satisfaction both concurrently and one year later. Analyses revealed that spouses' behaviors (e.g., expressions of positive affect, negative affect, communication skills, engagement) were associated with their self‐reported marital satisfaction both at the time of the narrative and with changes in marital satisfaction. We found particularly robust evidence for the role of husbands' negative affect during the narrative task in predicting changes in both spouses' marital satisfaction over time. Our results indicate that researchers and clinicians should carefully consider the influence of development on the associations between spouses' behaviors and marital satisfaction. Further, those seeking to improve marriages in later life may need to consider the meaningful role that gender appears to play in shaping the marital experiences of older couples.     

Mentalizing Family Violence Part 2: Techniques and Interventions

This is the second of two companion papers that provide an overview of mentalization‐based concepts and techniques when working with the seeming “mindlessness” of intra‐family violence. The focus of this paper is on general mentalization‐oriented approaches and specific interventions that aim to (1) disrupt the non‐mentalizing cycles that can generate intra‐family violence and (2) encourage the emergence of patterns of family interactions that provide the foundation for non‐violent alternatives. Various playful exercises and activities are described, including the taking of “mental state snapshots” and “selfies” in sessions and staging inverted role‐plays, as well as using theatrical masks and creating body–mind maps and scans. These can make “chronic” relationship issues come alive in session and permit “here and now” experiences that generate a safe context for mentalizing to take place. At the core of the work is the continuous focus on integrating experience and reflection. Without acute awareness of the thoughts and feelings occurring in the sessions, mere reflection is not likely to enable change. By increasing mentalizing in the family system, family members’ trusting attitudes grow, both within and outside the family.     

Supervising away from home: clinical,cultural and professional challenges

This paper explores some challenges of supervising clinical work of trainees, known as ‘routers’, who live in countries with diverse cultural, social and political traditions, and the analysts who travel to supervise them. It is written as an evolving dialogue between the authors, who explore together the effects of their own culture of origin, and in particular the legacy and values of their own training institutes on the styles and models of analytic supervision. Their dialogue is framed around the meaning of home and experiences of homesickness for analysts working away from home in an interactive field of strangeness in countries where analytical psychology is a relatively new discipline. The authors outline the findings from their own qualitative survey, where other supervisors working abroad, and those they have supervised, describe their experiences and their encounters with difference. The dialogue ends with both authors discussing what they have learned about teaching and supervising abroad, the implications for more flexible use of Jungian concepts, and how such visits have changed their clinical practice in their home countries.     

Where East meets West: in the house of individuation

The psychological process of individuation as experienced in Jungian work may lead to states of consciousness that resemble advanced spiritual developments across religious traditions and cultures. This is where Westerners may reach a common ground with the East. In the essentials and with respect to the final goal there is little difference among the many ways to the self, even if the cultural features in the landscape are disparate. In late stage Jungian analysis and individuation and in what Erich Neumann calls ‘centroversion’, the personal and the impersonal aspects of the personality accumulate around the ego‐self axis to form a composite identity. In this complex structure the ego does not vanish but is joined to the impersonal archetypal levels of the psyche and identity thus becomes at once individual and archetypal. This is the third stage of conjunction as described by Jung in Mysterium Coniunctionis and it is identical to the type of consciousness depicted in the final scenes of Zen Buddhism's Ten Ox‐Herding Pictures.