Family Therapy Research Articles

Engaging adolescents in family therapy: The role of English slang and digital communication norms in therapeutic settings

Adolescence is a critical stage marked by rapid cognitive, emotional, and social development, often presenting challenges within familial relationships. Family therapy serves as a vital intervention to address these challenges, yet engaging adolescents in the therapeutic process can be complex. This review explores the significance of English slang and digital communication norms in facilitating rapport and effective communication between therapists and adolescents in family therapy settings. In contemporary society, English slang and digital communication have become integral aspects of adolescent culture. Adolescents frequently employ slang terms and digital platforms to express themselves, communicate with peers, and navigate their identities. However, these informal modes of communication may pose barriers in traditional therapeutic settings where formal language is often prioritized. Recognizing the importance of meeting adolescents on their own communicative terms, therapists are increasingly integrating slang and digital communication norms into family therapy sessions. By incorporating familiar language and mediums, therapists can create a more inclusive and relatable environment, fostering trust and engagement with adolescent clients. Moreover, the utilization of slang and digital communication norms in family therapy promotes authenticity and enhances the therapeutic alliance between adolescents and therapists. Adolescents feel understood and validated when therapists demonstrate an awareness and acceptance of their linguistic and technological preferences, leading to increased participation and investment in the therapeutic process. However, the integration of slang and digital communication in family therapy requires careful consideration and ethical awareness. Therapists must balance the use of informal language with maintaining professional boundaries and respect for cultural diversity. Additionally, therapists should remain mindful of the potential implications of digital communication, including privacy concerns and the blurring of therapeutic boundaries. Understanding and incorporating English slang and digital communication norms are essential for effectively engaging adolescents in family therapy. By embracing adolescents' preferred modes of expression, therapists can foster meaningful connections, facilitate communication, and promote positive therapeutic outcomes within the familial context.

The Ackerman Institute: a journey of culture and diversity over six decades. A conversation with Evan Imber‐Black

AbstractThe Ackerman Institute for the Family, established in 1960 by Dr Nathan Ackerman, stands as one of the oldest and most respected family therapy institutes in the United States. Ackerman pioneered the integration of systemic insights into group settings, emphasised the crucial role of family in therapy, and advocated for the advancement and acceptance of family therapy. ‘The Ackerman’ played a pivotal role in launching Family Process, the first journal dedicated to academic activities in family therapy. Diversity and inclusion have been central tenets of Ackerman philosophy, evident in its programs, training courses, and staff composition. This commitment has produced a veritable cadre of family therapy leaders who have contributed significantly to both the Ackerman Institute and the profession, influencing policy decisions and clinical practices. One of the most esteemed and respected thought leaders and innovators of our field, who played a vital role in the legacy of several institutions, including the Ackerman, is Dr. Evan Imber‐Black. She served as a long‐time faculty member and director of the Ackerman Center for Families and Health. Her expertise encompasses the exploration of family rituals and family secrets, with a focus on the importance of rituals in providing meaning, identity, and connection across diverse cultures and family life cycles. As editor of Family Process for 8 years, she highlights the importance of examining scholarly work in the context of cultures as a requirement – we do not stand outside the culture – we are active participants. This paper is based on a conversation with Dr Evan Imber‐Black, held in June 2023, delving into her personal and professional experiences, her connection to the Ackerman Institute, and her influential work on family rituals and secrets. Through this exploration, the paper sheds light on her commitment to diversity and the lasting impact of Dr Imber‐Black's contributions to family therapy.

Digital communication tools in family therapy: A review of opportunities and challenges for English-Speaking practitioners

Digital communication tools have revolutionized the field of family therapy, offering both opportunities and challenges for English-speaking practitioners. With the proliferation of technology, therapists have access to a wide array of platforms and applications that can enhance therapeutic interventions. However, integrating these tools into practice requires careful consideration of ethical, legal, and clinical implications. Digital communication tools offer numerous advantages for family therapy practitioners. Teletherapy platforms enable therapists to reach clients in remote locations or those with mobility constraints, expanding access to care. Video conferencing allows for face-to-face interactions, facilitating rapport building and nonverbal communication cues essential for effective therapy. Additionally, digital tools such as secure messaging apps or virtual whiteboards enhance communication between sessions, fostering continuity of care and homework completion. Online support groups and forums provide clients with opportunities for peer support and community engagement, supplementing traditional therapy approaches. Despite their benefits, digital communication tools pose significant challenges for English-speaking practitioners. Ensuring confidentiality and data security is paramount, requiring adherence to stringent privacy regulations such as HIPAA (Health Insurance Portability and Accountability Act). Therapists must navigate issues of informed consent, boundary maintenance, and emergency protocols in the digital realm. Moreover, technological barriers, such as internet connectivity issues or lack of digital literacy among clients, can hinder the effectiveness of therapy sessions. Cultural considerations also play a role, as language barriers or cultural differences in technology use may impact therapeutic engagement. Digital communication tools offer English-speaking family therapy practitioners unprecedented opportunities to enhance therapeutic interventions. However, these tools come with inherent challenges that must be addressed to ensure ethical and effective practice. By carefully navigating the opportunities and challenges presented by digital communication tools, therapists can harness the power of technology to improve client outcomes and advance the field of family therapy.

Experiences of post‐divorce parentification and parental affection: Implications for emerging adults' well‐being

ABSTRACTObjectiveThe present study examined how emerging adults' perceived parentification and parental affection toward themselves and their sibling after parental divorce are associated with mental health so that researchers and practitioners can better understand the influence of sibling dynamics in this process.BackgroundAlthough parentification may be prevalent within the context of parental divorce, little is known about how perceived sibling parentification and parental affection (i.e., individual and sibling) are related to individuals' reports of mental health for those who have experienced parental divorce.MethodThe sample consisted of 106 emerging adults with a living biological sibling and parents who divorced. Hierarchical regressions were used to investigate associations among levels (i.e., individual and sibling) and differences (i.e., individual versus sibling) in self‐perceived post‐divorce parentification and parental affection and outcomes (i.e., current symptoms of depression, anxiety, and stress).ResultsHigher reports of self‐perceived parentification were significantly related to higher reports of participants' depressive and stress symptomology. Greater self‐perceived parental affection for siblings had a significant positive relationship with the aforementioned outcomes.ImplicationsImportant implications on the potentially long‐lasting effects of perceived parental treatment are included for divorce education facilitators and family therapists working with divorcing parents.

The Role of the Dietitian within Family Therapy for Anorexia Nervosa (FT-AN): A Reflexive Thematic Analysis of Child and Adolescent Eating Disorder Clinician Perspectives.

Despite dietitians being important members of the multidisciplinary team delivering family therapy for anorexia nervosa (FT-AN), their specific responsibilities and roles are unclear and their involvement in the treatment can be a contentious issue. Clinicians (n = 20) experienced in the delivery of FT-AN who were working at a specialist child and adolescent eating disorder service responded to an online survey about their experience of including a dietitian in FT-AN and how they understand the role. Both categorical and open-ended questions were used. Reflexive thematic analysis was used to analyse the qualitative free-text responses of clinician perspectives on the role of the dietitian in FT-AN. All clinicians agreed that dietetics had a role within FT-AN and most frequently sought dietetic involvement in the early phases of FT-AN. Reflexive thematic analysis of responses identified three main themes. These were (1) collaboration is key, (2) confidence as a core consideration and (3) case-by-case approach. These themes evidenced the role of the dietitian within FT-AN and highlighted both the benefits and concerns of this involvement. This study demonstrated that dietitians can take a core role as collaborators within therapy-led teams that facilitate joint working and sharing of expertise. However, dietetic input should be considered on a case-by-case basis, given its potential for creating an over-focus on nutrition and potentially diminishing parental confidence in feeding. When indicated for selected cases, nutritional counselling should be offered in joint sessions with the therapist rather than separately. The findings of the study were limited by the small sample size of participants recruited from a single centre and heterogeneity in the professional background of respondents. Although the integration of dietetics within the multidisciplinary team and the ability of dietitians to individualise patient care can enhance FT-AN treatment, potential benefits and disbenefits should be considered for each case.

The distress of one‐dimensional fertility in an African family

AbstractSeveral Euro‐American approaches to couple and family therapy have been instrumental in promoting successful practice of couple and family therapy in continental Africa. This article, however, describes one instance in which an African couple's distress of one‐dimensional fertility could not be resolved by drawing solely from the Euro‐American family therapy tradition. One‐dimensional fertility is defined as a crisis that arises in conditions of sonlessness or daughterlessness in a marriage, that is, in situations where there are only male or female children born to the marriage. The use of medical intervention through the prescription of drugs often worsens rather than enhances the psychological well‐being of couples who suffer from the distress of one‐dimensional fertility. Therefore, it is considered beneficial to encourage the development and recognition of psychological literature that suggests what to be done to control such a distress without recourse to the use of medication or the complicated and sensitive procedure of in vitro fertilisation. The article suggests that the leading intervention package for attending to the challenge of couples with the distress of one‐dimensional fertility entails the exercise of inducting them into the principles and practice of the fertility awareness‐based method of family planning known as the billings ovulation method that is in harmony with the African cultural perspective.

Embracing the other: Revisiting the epistemological foundations of family systems therapy.

Family systems therapy originated in the 1960s, 1970s, and 1980s through the work of innovative thinkers and clinicians. However, despite the creative contributions of the mentioned colleagues and of later innovations in family therapy theory and practice, it seems as though the dominant culture of establishment psychiatry in the United States (and in most Western countries) to this day has not seriously incorporated relationships, social context, or community connectedness into the treatment of individuals with psychiatric diagnoses. For the "psychiatric" patients diagnosed according to the DSM-5, the dominant underlying epistemological perspective is the medical "scientific" paradigm. Within this approach there is a dearth of reflections about the truthfulness of so-called "empirical facts" and a lack of skepticism about the techniques of "measurement" of the psychiatric illness. The alternative, relationship-oriented, context-sensitive, and community-connected thinking paradigm is highlighted here in contrast to the "psychiatric" foundation. This paradigm consists of (a) the awareness that all human Subjects (including "psychiatric" clients) are constituted as such by their relational connection to others; (b) the awareness of our sensitivity to and embeddedness in a socio-economic, cultural, and racial context; and (c) the awareness of our involvement in and connectedness with many kinds of communities.

Couple differentiation and health-related quality of life.

The purpose of this study was to examine whether couple differentiation influenced mental and physical health-related quality of life in couple members. Data for this study were derived from a larger study at a couple a family therapy clinic. One hundred and thirty-three couples were included in a latent profile analysis, and seventy-two couples were included in analyses of mean differences. The latent profile analysis resulted in three distinct groups by level of couple differentiation: high, moderate, or low in differentiation of self. Analyses of variance indicated evidence that couple differentiation influenced health-related quality-of-life measures. Findings are discussed in the context of Bowen Family Systems Theory and the existing literature.

Transforming a body: Sculpting in therapy

ABSTRACT The writer shares the course of treatment with a gender nonbinary teenager and their parents that utilized techniques from drama therapy, relational self psychology, sculpting, and family therapy. Following the rupture and attempted repair with the patient’s parents, work with the patient and their family finally led to a joint decision to terminate treatment. This case study discusses the clinical challenges and implications of working within a family system in which parents’ values misalign with the psychotherapist’s treatment goals. Trigger warning This paper contains misgendering that can emotionally trigger some individuals.

From training to practice: Reflections on implementing open dialogue across secondary mental health services

PHOTO CREDIT: George MiltonThis article describes the implementation of Open Dialogue, an integrative approach drawn from systemic family therapy, dialogical theory, and social constructionism, across a range of mental health services within an NHS Trust. Reflections are given from staff working in Early Intervention in Psychosis and Acute Inpatient services, on the experience of training and the feasibility of implementing this approach. The conclusion draws together the learning gained and challenges experienced, as well as identifying areas for future development.

Who and what supports systemic working in a learning disabilities context?

PHOTO CREDIT: Hannah Busing, UnsplashThis article sets out some of the many ways in which systemic working can find a place in Learning Disability (LD) services. It covers ways in which systemic working can influence different aspects of work in an LD service, possibilities for embedding systemic approaches in Positive Behaviour Support (PBS) work in an Enhanced Support Service (ESS), systemic consultation in an LD team, systemic working in a forensic LD service and a specialist LD family therapy service. We hope the article offers a range of ideas which others can draw upon in thinking about their own context, practice and future possibilities.

Sitting with uncertainty to create a rich nourishment for clinicians: Developing a systemic family therapy clinic for psychosis in community adult mental health team

PHOTO CREDIT: Priscilla Du PreezSystemic practice can be a rich source of fuel for services, nourishing clinicians and families. To us, systemic thinking supports the creation of space, taking pause, being with and seeing the bigger picture. It is about multiplicity, of idea, of voices, of people and cultures coming together to make sense together. In a culture which is struggling under the weight of austerity, the pandemic and ongoing limitations of practice due to staff shortages and limited resources at a time of extreme demand, we need something to open ourselves and our clients to new possibilities and build trust and safety.This paper will describe systemic family therapy within a secondary care community mental health team. You will hear the voice of Jo, a consultant clinical psychologist and systemic psychotherapist and Funmi, an assistant psychologist in the team. We will discuss decision-making in this work and explore the experiences of the reflecting team, highlighting the value of a systemic approach in secondary adult mental health. The straightest route is not always the most effective or nourishing, sometimes it takes the windy path to get the richest source of progress.

Dynamic Narrative Therapy: A Metamodern Integration of Narrative, and Strategic Family Therapy

Dynamic Narrative Therapy: A Metamodern Integration of Narrative, and Strategic Family Therapy

Monthly engagement with EIP keyworkers was associated with a five-fold increase in the odds of engagement with psychosocial interventions.

Early intervention in psychosis (EIP) supports people who are experiencing their first episode of psychosis (FEP). A new Model of Care (MoC) for EIP services was launched in Ireland in 2019. Three EIP demonstration sites were chosen to test this MoC through a 'hub and spoke' approach. These services were a new way of organising care for people experiencing FEP, based upon a recovery model of care, and which sought to standardise care, improve access by clinically led multidisciplinary teams. This included newly created EIP keyworker roles whereby keyworkers assumed responsibilities regarding assessment, comprehensive individual care planning and coordination of care. A mixed methods design utilising the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were utilised. Descriptive analyses and logistic regression were performed to examine how increased keyworker engagement influenced the use of other psychosocial interventions within the EIP demonstration sites. Thematic analyses was used for qualitative data. There was a strong positive relationship between keyworker contacts and psychosocial interventions offered. Specifically, the odds of achieving at least monthly engagement with cognitive behavioural therapy for psychosis (CBTp; (5.76 (2.43-13.64), p < 0.001), and behavioural family therapy (BFT; (5.52(1.63-18.69, p < 0.006)) increased by fivefold with each additional monthly keyworker contact. For individual placement support (IPS) each additional monthly keyworker contact was associated with a three-fold increase in the odds of achieving monthly attendance with IPS (3.73 (1.64-8.48), p < 0.002). Qualitative results found that the EIP keyworker role as viewed by both service users and staff as a valuable nodal point, with a particular emphasis on care coordination and effective communication. This study advances the understanding of keyworker effects through qualitative evidence of keyworkers functioning as a "linchpin" to the service, while the positive response association between keyworker contacts and engagement with other services provides quantitative support for keyworkers reducing the organisational or structural barriers to service access. Given the importance of these positions, health systems should ensure that EIP programmes identify qualified and experienced staff to fill these roles, as well as allocate the appropriate funding and protected time to support keyworker engagement and impact.

Service evaluation of an embedded Early Intervention in Psychosis programme.

An average of 1300 adults develop First Episode Psychosis (FEP) in Ireland each year. Early Intervention in Psychosis (EIP) is now widely accepted as best practice in the treatment of conditions such as schizophrenia. A local EIP programme was established in the Dublin South Central Mental Health Service in 2012. This is a cross-sectional study of service users presenting to the Dublin South Central Mental Health Service with FEP from 2016 to 2022 following the introduction of the EIP programme. We compared this to a previously published retrospective study of treatment as usual from 2002 to 2012. Most service users in this study were male, single, unemployed and living with their partner or spouse across both time periods. Cognitive Behavioural Therapy for psychosis was provided to 12% (n = 8) of service users pre-EIP as compared to 52% (n = 30) post-programme introduction (p < 0.001), and 3% (n = 2) of service users engaged with behavioural family therapy pre-EIP as opposed to 15% (n = 9) after (p < 0.01). Rates of composite baseline physical healthcare monitoring improved significantly (p < 0.001). Exclusive allocation of multidisciplinary team staff to EIP leads to improved compliance with recommended guidelines, particularly CBT-p, formal family therapy and physical health monitoring.

Emotional arousal and reflective functioning among parents participating in attachment-based family therapy for LGBTQ+ young adults and their nonaccepting parents

Objective Parents’ rejection of their LGBTQ + young adults can have a negative impact on their young adult’s psychological welfare, and on the young adult-parent relationship. Parents’ ability to reflect on their child’s pain and unmet needs is thought to evoke empathy and compassion, and reduce rejection. Empirical and clinical evidence suggest that parents’ level of reflective functioning (RF) is impacted by their level of emotional arousal (EA). This study examined the association between parents’ EA and RF within the context of attachment-based family therapy for nonaccepting parents and their LGBTQ+ young adults. Methods 43 therapy sessions drawn from six different cases were coded for parental RF and EA, based on 30-second segments. This generated a total of 343 observations for analyses. Results Hierarchal linear modeling revealed that parents’ level of RF was a function of their concomitant EA, with moderate levels of arousal predicting the highest RF levels. Conclusion Moderate EA may facilitate optimal parental reflective functioning. With nonaccepting parents, who typically present for treatment with high levels of maladaptive fear and shame, therapists would do well to assess their level of arousal and, when indicated, employ downregulating interventions before inviting them to reflect on their young adult’s experience and needs.

Comparing the effectiveness of structural family therapy and mindfulness-based family therapy in cohesion and adaptability in couples with marital dissatisfaction

The present study was conducted with the aim of comparing the effectiveness of structural family therapy and mindfulness-based family therapy in cohesion and adaptability in couples with marital dissatisfaction. The research was a semi-experimental study with a pretest-posttest control group design and a two-month follow-up. The research population comprised all couples with marital dissatisfaction who referred to family counseling centers in Tehran (Iran) in the first 6 months of 2021. Out of this number, 30 couples with marital dissatisfaction were selected using convenience and purposive sampling and were randomly assigned to three groups: structural family therapy, mindfulness-based family therapy and the control group. The research tool was the Family Adaptability and Cohesion Evaluation Scale by Olson, Portner and Lavee (1996). In order to analyze the data, repeated measures analysis of variance was used. The findings demonstrated that there is a significant difference between the two experimental groups and the control group in cohesion and adaptability scores. This means that both experimental groups had a significant effect on cohesion and adaptability components (p < 0.05). Further, the results suggested that there is a significant difference between the two experimental groups of structural family therapy and mindfulness-based family therapy in terms of the effectiveness in the components of cohesion and adaptability. Accordingly, the effect of structural family therapy on couple's cohesion and adaptability was greater than that of mindfulness-based family therapy (p < 0.05).

Remote delivery of cancer genetic testing in veterans with metastatic prostate cancer: A Million Veteran Program study.

60 Background: Germline pathogenic alterations are found in approximately 10% of men with metastatic prostate cancer (mPC) and can inform precision therapy, surveillance, and cancer prevention for family. National guidelines recommend germline genetic testing be offered to all men with mPC, yet uptake of testing in the community has been documented to be 6-12% with many barriers to testing. We conducted a study to determine uptake of testing using remote consenting and testing for veterans with mPC who had participated in the Veteran’s Administration Million Veteran Program (MVP). We wanted to know if remote testing could overcome limited point-of-care counseling and ordering to increase uptake of germline testing. Methods: This prospective study enrolled veterans who participated in MVP study with a diagnosis of mPC. Veterans were contacted by mail with an option to opt-out of further contact. Those who did not opt-out were mailed information regarding the study and received a follow-up phone call to establish interest in germline testing with a CLIA-level germline test (BROCA). Those expressing interest provided verbal informed consent and were mailed a saliva collection kit for a multigene cancer predisposition gene panel test (University of Washington). Results were disclosed by phone and mailed to the patient with genetic counseling support and was also sent to the oncology provider by email, phone or both. Two research coordinators and two part-time genetic counselors provided review of consenting, counseling and return of results. Results: As of September 17, 2023, 1952 veterans who were alive with an incident diagnosis of mPC were identified through MVP and did not opt out of further contact. Informational letters were sent to the home address of all eligible participants. 681 (22%) of veterans were reached and completed informed consent. All participants were then sent a saliva kit and 432 (63%) completed testing, with 23 tests currently pending. Among the participants, 70% were White, 21% were Black, 0.5% Asian and 8% unknown. Thirteen percent (53/409) were found to have a germline pathogenic variant. Conclusions: We evaluated uptake of germline testing using a remote, VA system-wide approach to identify and offer genetic testing for veterans with mPC with access and cost issues removed. We completed germline testing at rates significantly higher than those reported in the community with modest personnel requirements, while also reaching a more diverse population of patients. Remote genetic testing can improve uptake of testing in large integrated health care systems.

Understanding the Psychology of Grief

Grief is a normal response that occurs after the loss of a close one and is a process that takes time to heal. It can be defined as the normal process people go through to readjust their lives after a loss. To understand the psychology of grief, it is important to understand the theoretical and conceptual framework of grief and use effective treatment approaches to move beyond grief. In this chapter, a theoretical framework of grief, along with myths and cultural im- plications about the grieving process, and normal and pathological grief processes diagnosed as persistent complex bereavement disorder are mentioned. Also, it is mentioned about effective grief therapy methods such as grief coun- seling, family therapy approaches, expressive art therapy, cognitive-behavioral therapy, interpersonal psychother- apy, complicated grief therapy, and existential therapy. This literature review study examines the grief process and psychology in different aspects, understanding the theoretical framework of 21st century grief therapy approaches to provide a structure to recognize and realize grief multidimensionally and treat it integratively with using several techniques from various therapeutical schools.

Inclusion and anti-racism work as performance or deep work? It literally is either-or: A qualitative study in the CFT field.

This study explores the experience of promoting inclusion and anti-racism work as either performance or deep work in the couple and family therapy (CFT) field through narrative qualitative analysis. While performance-based approaches focus on meeting external expectations and diversity quotas, deep work involves critical self-reflection, ongoing learning, and a commitment to addressing systemic inequalities. The paper prioritizes how deep inclusion assists with developing new approaches to creating meaningful and lasting change in teaching, research, and clinical work in the CFT field. Some professionals in the field include educators, researchers, and therapists who are engaged in anti-racism work, a recognition of the impact of systemic racism on family dynamics and therapeutic interventions, and a commitment to centering the voices and experiences of marginalized individuals and communities. Implications present a need for ongoing education, training, and support for professionals in the CFT field and other family science and family mental health-related professions. This study also identifies limitations and future directions for research in promoting inclusion and anti-racism work in family science and family mental health-related fields. It is essential to promote inclusion and anti-racism as deep work to create more inclusive and equitable teaching, research, and therapeutic environments that value the experiences of all individuals and communities. Challenges include resistance from shaking systems and making ourselves and others vulnerable with uncomfortable and continuous conversations. Our primary goal is to contribute to and inspire dialogue about the perspectives CFTs and other mental health-related professionals are taking in the relationship to inclusion and anti-racism work.