Family Therapy Process Research Articles

Bolstering family therapy: Assimilating EMDR into ABFT in youth residential treatment.

The psychotherapy field has a long history of integration to improve treatment effectiveness. One type, assimilative integration, offers innovative opportunities to family therapy to incorporate the clinical and research contributions of different approaches. This paper contributes to the literature on integration by exploring how Eye Movement Desensitization and Reprocessing (EMDR) can be assimilated into Attachment-Based Family Therapy (ABFT) for youth in residential psychiatric treatment. ABFT seeks to improve attachment security to parental figures by asking adolescents and young adults to discuss attachment ruptures. This process, specially designed for patients with internalizing disorders, can provoke anxiety, particularly for a patient population that commonly has a history of trauma and adverse life experiences. EMDR is a first-line therapy for post-traumatic stress disorder and has the potential to be effective in treating various other mental health conditions. When patient emotional withdrawal or dysregulation due to breaches in trust between child and parent emerges in ABFT, EMDR may help desensitize associated memories and bolster the family therapy process. The authors provide an overview of both models, and a detailed case study as an example. The paper concludes with a discussion on implications, integration efforts, and limitations.

Identification of counselors competencies in family therapy with symptomatic cycle based on Joseph A. Micucci’s Theory

In implementing guidance and counseling services at schools, adolescent problems have been a classic problem for a long time. During adolescence, known as the storm and stress period, emotions tend to be explosive and uncontrollable. They tend to blow up their feelings towards their parents or siblings. For some families, the situation brings them into family conflict. Families who only deal with the problem behavior will make the symptoms more persistent, known as the symptomatic family cycle. Micucci argues that the root of the problem is not in the problematic behavior of adolescents but in the patterns of interaction within the family. This article uses a literature review focusing on debriefs on the Micucci book. We found that the most crucial role of the counselor is to help families change symptom-related patterns of interaction. The main principle: The therapist or counselor replaces automatic and reactive responses among family members with more thoughtful and planned responses. Family therapy has five stages: beginning, identification, reframing, core treatment, and addition. Based on Micucci’s guidelines, the family therapy process requires all the competencies: pedagogic, personality, social, and professional. Personal competence and professional competence become the basis of the therapy process, while pedagogic competence and social competence complement and support the success of the family therapy process. Family therapy can be an alternative for the counselor to help adolescents with symptomatic problems.

Alcoholism as a way of dealing with emotions and transformation in relational family therapy

Alcoholism, which is a major public health and social problem, can be viewed from several perspectives, as its occurrence is a multifaceted phenomenon in terms of its development (causes), effects, and maintenance. The Relational Family Therapy paradigm looks at alcoholism and its dynamics in relation to dysfunctional affect regulation. Dysfunctional affect regulation and the general inability to manage emotions are often mentioned in relation to the development and maintenance of alcohol addiction. The mechanism of affect regulation generally refers to internal processes that allow an individual to maintain their emotions to a degree that feels still bearable for them. According to these assumptions, alcoholics drink in order to cope with difficult emotions, either because they have more negative emotional states than others do, or because they lack the internal resources to cope with these negative emotions. For them, consuming alcohol is a series of repeated attempts to regulate heavy emotions, which often stem from painful past experiences. The process of Relational Family Therapy, therefore, as treatment of addiction, focuses on identifying and transforming the dysfunctional regulation of affect, which is behind addictive behavior. By means of action research methodology, this paper presents the approach of Relational Family Therapy in working with an alcoholic client, with an emphasis on the aspects of affect regulation. We show how the client’s alcohol use appeared as a dynamic of inappropriate regulation of a painful core affect. In the process of Relational Family Therapy, a more functional regulation of the core affect was established, thereby reducing symptomatic behavior (alcoholism) in the client.

Confronting Stressors in the Therapy Room: Emergent Life Events in a Multiple Evidence-Based Practice Implementation Context

ABSTRACT Life stressors, or emergent life events, have the potential to interfere with child and family therapy processes and have been cited as barriers to implementing evidence-based practices (EBPs) for child mental health in community settings. The purpose of this study is to characterize the discussion of emergent life events in therapy sessions and examine its association with therapist delivery of EBP strategies, all within the context of system-driven implementation of multiple EBPs. Data were drawn from 680 audio-recorded psychotherapy sessions in which an EBP was delivered to 274 youth receiving care from 103 community therapists in 14 mental health agencies. Emergent life events were mentioned in 143 sessions (21.0%), with 77 sessions (11.3%) containing a mild intensity emergent life event and 66 sessions (9.7%) containing an emergent life event of at least moderate intensity (moderate to severe). Multi-level analyses found that session/EBP-, child-, therapist-, and agency-related factors were associated with the reporting of emergent life events in session. In addition, the reporting of an emergent life event of at least moderate intensity (moderate to severe) was associated with less extensive observed delivery of EBP strategies within the same session, whereas the reporting of an emergent life event of mild intensity was not significantly associated with the extensiveness of EBP strategy delivery. Emergent life events can influence the delivery of EBP strategies in community mental health services.

"You helped me out of that darkness" Children as dialogical partners in the collaborative post-family therapy research interview.

Applying Dialogical Methods for Investigations of Happening of Change (DIHC), this study investigated how children who had been diagnosed with an oppositional defiant or conduct disorder participated in a collaborative post-therapy research interview and talked about their experiences of family therapy. The results showed that the children participated as dialogical partners talking in genuine, emotional, and reflective ways. Encountered as full-membership partners, the children also co-constructed meanings for their sensitive experiences. However, their verbal initiatives and responses appeared in very brief moments and could easily have been missed. The collaborative post-therapy interview offered a safe forum for co-reflection by participants on what they had found useful or difficult in the family therapy process. In this interview setting, the family first listens to reflection by the therapists on the therapy process and their thoughts on some of the family's related sensitive issues. The results indicate that when therapists present themselves as not-knowing, receptive and accountable, therapists may facilitate reflection for all family members, including children.

Evaluating a Functional Family Therapy Intervention: Challenges and Lessons Learned

Purpose: This case study is the introspective account of the evaluation process of Functional Family Therapy (FFT) as implemented in Middlesex County in New Jersey between 2005 and 2011. The study presents challenges and issues in evaluation falling into three main categories. Methods: The case study is based on the recollections and documented experiences of the author who was responsible for all major aspects of the evaluation including designing the study, collecting the data, and handling daily evaluation activities. Results: The author differentiated among three main categories of challenges. In respect to research design, the relative merits of experimental versus nonexperimental designs and quantitative versus qualitative research methods are discussed. The second set of issues involves developing and exercising the social competence skills necessary to form working partnerships with service providers. The third set encompasses logistical barriers encountered during daily evaluation activities. Conclusions: The challenges and lessons learned from conducting the outcome evaluation of FFT are situated within scholarly debates on evaluation research, with the goal of providing further insights into the on-the-ground implementation and process of program evaluations. The experiences, recollections and processes illustrate challenges and solutions applicable to evaluations of other family-based violence prevention interventions.

The helpfulness of reflecting teams in family therapy

Reflecting teams (RTs) are used in family therapy in order to introduce multiple perspectives and provide the ‘difference that makes a difference’. Research suggests that reflections made by an RT may be a factor in the change process for family members. This study aims to further the understanding of the helpfulness of reflections in family therapy, thus supporting RTs to be as effective as possible. A quantitative longitudinal questionnaire method was used in order to collect data on family members’ perceptions of the helpfulness of reflections made by an RT during their family therapy sessions. The results show that certain types of reflections are less helpful than others and the helpfulness of reflections was found to contribute to the change process for family members. The results are discussed along with reflections on the research process, limitations and recommendations for further research.Practitioner points Some types of reflections made by the reflecting team are more helpful than others, so using these more helpful reflection types may optimise progress in family therapy Reflections contribute to the change process in family therapy, therefore reflecting teams are valuable to include in family therapy sessions

Microlevel Advocacy: A Common Process in Couple and Family Therapy.

Advocacy is an essential element to mental health practitioners' professional identity. Some scholars contend that many couple and family therapists lack the skill set needed to effectively advocate. However, these researchers often discuss advocacy solely on the macrolevel, which makes advocacy appear unidimensional and may feel out of reach for many practitioners. In this article, we argue that advocacy is not unidimensional, but consists of two levels: macro- and microlevel advocacy. Microlevel advocacy is client-centered and is effectively performed by couple and family therapists on a regular basis. By broadening the definition of advocacy to include the microlevel, we argue that advocacy is a common process of couple and family therapy that cuts across therapy models and is interwoven into the very being of a couple and family therapist. We present in this article a comprehensive case vignette to illustrate how microlevel advocacy may be performed by CFTs. Clinical and training implications are offered to help clinicians begin to bridge the gap between micro- and macrolevel advocacies.

A Primer for the Use of Multilevel Models in Couple and Family Therapy Research

This article serves as a primer for understanding how to use multilevel modeling (MLM) techniques in couple and family therapy outcome and process research. It outlines the use of HLM and Mplus-two of many software programs that can perform multilevel modeling-and provides an applied example of using MLM to investigate the use of postsession feedback on couple satisfaction and change, as well as the influence of trauma on the use of postsession feedback. Two graduate students in COAMFTE accredited PhD programs read the primer and provided questions to the first author that arose. Answers to these questions have been incorporated throughout the explanation of this methodological approach in hopes of addressing common stuck points for those using MLM.

Teoria do posicionamento e terapia familiar: criando novas posições discursivas na relação entre mãe e filho

Seguindo a premissa Construcionista Social de que o indivíduo se constitui nas relações através da linguagem e partindo de um contexto prático do atendimento com uma família, o objetivo deste artigo é dar visibilidade ao processo de construção de novas posições discursivas para a relação de uma mãe e um filho, a partir do foco no processo de comunicação e do uso de uma metáfora. Teoricamente, nos apoiamos na compreensão do self em sua dimensão relacional. Metodologicamente, utilizamos a teoria do posicionamento como um recurso para dar visibilidade para o processo discursivo em terapia familiar, no qual uma mãe e um filho negociam posições alternativas para seu relacionamento. Concluímos, pela utilidade da teoria do posicionamento na experiência clínica, por permitir colocar em ação a ampliação da noção de identidade, substituindo o enfoque na unicidade pela possibilidade de múltiplas descrições de self.

Realizing Relational Preferences Through Transforming Interpersonal Patterns.

Family therapy has often been conceptualized as a conversational process whereby therapists and clients generate new meanings. Based on a 3-year study of conversational practices observable in successful family therapy processes of Chilean families with a child/adolescent who is engaged in disruptive behaviors, we looked for clinical examples of Transforming Interpersonal Patterns (TIPs). TIPs are a key aspect of the IPscope, a framework we used to explore the meaning-making processes in family therapy. TIPs constitute a novel approach to explore therapeutic processes by identifying empirically traceable conversational practices involved in generating "new meanings." TIPs are involved in bringing forth and discursively articulating ("talking-into-being") clients' preferred ways of relating and living (i.e., relational preferences or RPs). We analyze conversational data from successful family therapy sessions/treatments, and present an emergent model of five categories of conversational practices making up TIPs, namely: Preparatory TIPs, Identifier TIPs, Tracker TIPs, Transformer TIPs, and Consolidator TIPs. We have called them "realizers" because these conversational practices help families talk-into-being (or "make real") particular relational preferences. We also offer user-friendly descriptors of realizers' subcategories (e.g., Measuring TIPs) which may help practitioners to recognize, learn, and perform these conversational invitations. Theoretical consequences and future lines of research are discussed.

Musical Moments in the Creative Practice of Family Therapy

This article uses music as a metaphor for family therapy process and practice. The overture begins looking at the family using the symphony as an analogy highlighting insight into musical improvisation as integral to the progression of acceptance to change. Several other key music therapy strategies discussed include therapeutic songwriting, song discussions, and lyric substitution, all within the framework of family therapy. The finale concludes with a caution on the fundamental importance of building rapport rather than being too technique‐focused, for music itself is ultimately the social glue that binds people together.

The use of Theory in Family Therapy Research: Content Analysis and Update.

In this study, we evaluated 275 empirical studies from Journal of Marital and Family Therapy and Family Process from 2010 to 2015 on their use of theory, and compared our findings to those of a similar previous analysis (Hawley & Geske, 2000). Overall, theory seems to have become much better incorporated in empirical family therapy research, with only 16.4% of the articles not using theory in either their introductory or discussion sections. Theory appeared better incorporated in the introductory sections than in the discussion sections. Systems theory remained the most commonly used conceptual framework, followed by attachment theory. We discuss areas for improving theory incorporation in family therapy research, and offer suggestions for both family therapy researchers and educators.

Considering Family Therapy Process and Relevant Theories

Family is more than a group of individuals living together in certain physical and psychological space. In other words, family is a natural and social system with specific features. It is a system postulating certain principles, roles, power structure, socializing relationships and communications, talking methods, and problem solution for effective performance of diverse duties.Most difficulties in life are traceable best way within family. Families are powerful forces in their entirety effective on members’ health or compatibility, whether in their advantage or disadvantage. Consequently, family therapy is interference concentrated on dealings among family members that attempts to enhance family function as a unit made of individual members of family.

Badanie przebiegu terapii rodzin – prace nad polską wersją narzędzia SCORE-15

The aim of the paper is to demonstrate progress of the works on the Polish version of SCORE-15 and the results of the preliminary data analysis of changes in the process of family therapy, obtained with this tool. The works on the Polish version, ongoing since 2010, were inspired by the Research Committee European Family Therapy Association EFTA. Since the Polish version of SCORE-15 will be make public and published on EFTA website in the near future, therefore, it is important that people interested in the tool know the context of its development. The Polish version of SCORE-15, the tool designed to examine the process of family therapy, was used. The comparison of the results obtained by family members before the first family session and before the fourth one and psychotherapists' assessments show that the perception of the weight of the problem with which the family members came to therapy is indeed significantly lower already after three sessions of family therapy. Additionally, the obtained results show great coherence of the assessment of the family therapy progress in families and their therapists. The preliminary analysis of data obtained during the research project conducted in Outpatient Family Therapy Clinic, Department of Adult, Child and Adolescent Psychiatry, University Hospital in Krakow and in Laboratory of Psychology and Systemic Psychotherapy, Department of Child and Adolescent Psychiatry, Jagiellonian University Medical College between 2010 and 2014 revealed that SCORE-15 is a useful tool in research on changes in the systemic family therapy process.

Re-Storying Incest: Four Women and Three Generations

This case study is about a family therapy process where members of two generations meet together, reframe painful memories, and acquire a new understanding of incest that will help the parents and future generations move on in a healthy way. The authors used their Etnia Terapeutica approach, where the therapeutic system is an ethnic meaning generating system. Here cultural, ethnic, racial, and other embodied characteristics of both therapists and clients create a fabric that sustains and enriches the process of constructing new understandings and possibilities.

Reflections From Behind the Screen

Since Tom Andersen developed the use of reflecting teams to facilitate the progress and process of family therapy, little empirical evidence has emerged regarding their effectiveness or use in therapeutic practice. Reflecting teams are typically embraced by family therapists as a positive mechanism for enhancing practice and thus it is important that research explores how they are utilized. In this article, we draw upon videotaped data of naturally occurring family therapy from the United Kingdom. Using conversation analysis, we identified three performative actions related to interrupting the therapeutic conversation to consult with a reflecting team. We found that therapists had difficulty exiting therapy, that on some occasions exit was hindered, and that there were disturbances in feeding back the reflections of the team. By examining the use of teams in real practice, we were able to make a number of recommendations for practicing family therapists to facilitate the use of this valuable resource.

Social Uterus: A Developmental Concept in Family Therapy for Psychosomatic Disorders

The article introduces a concept of social uterus as an integrative model of family development. The concept has been gradually developed by two of the authors of the article through extensive clinical work with individuals and families during the last two decades. It has shown to have clinical validity, particularly in family therapy for psychosomatic disorders and various chronic somatic diseases. In the article, we first present a short description of our perspective on psychosomatic issues. We also give some information about the broader context of psychosomatic medicine and family therapy in our country. The main part of the article focuses on the concept of social uterus in detail. With regard to process of family therapy, both promising and controversial aspects of the concept are discussed. We conclude with some ideas concerning a need for collaborative health care in the treatment of psychosomatic disorders.

Family work in geriatric psychiatry

Dementia and other late-life conditions in neuropsychiatry impose a heavy burden on society as a whole and in families in particular. A number of clinical presentations involving family aspects may be seen in clinical practice in a range of diagnoses (Alzheimer's disease, other dementias, depression or any other psychiatric disorder in the elderly). As a consequence, there is a growing trend towards working with families in geriatric psychiatry. Marital issues are not a frequent target for specific clinical intervention, but couple therapy may be useful regardless of age. The effectiveness of family systems therapy has not been widely evaluated in psychogeriatrics, so far. However, it may be a powerful resource when family dynamics must be addressed, mostly in families where dysfunctional circularities precede the outburst of severe clinical problems. More often, family psychoeducation will be the first indication, in different formats, settings and levels of intensity. However, context reading and systemically-informed work are not restricted to classical family therapy and do not imply it. Is has been suggested that family psychoeducation should sometimes include a stronger family systems perspective. Structured and feasible family assessments should always precede interventions. Indeed, they are a first step of the intervention itself, while necessarily reviewed through the course of family work. Ageism perhaps still influences to some extent health professionals' attitudes, including the ones of family therapists, leading to the underutilization of family approaches in the elderly. However, working with families remains a core process in geriatric psychiatry and family therapy may be a powerful resource in particular cases.

Therapeutic Process as a Means to Navigate Impasse? Reflections on a Complex Case of Crosscultural Adolescent Family Therapy

This article explores the process of family therapy with a Turkish‐speaking single‐parent family with four children in which suicidal behaviour and family violence have become the norm. The following example describes a pivotal experience early within my career as a family therapist. The universality of first, being a beginner family therapist, and second, receiving a referral of a daunting, difficult case has led me to share my experience here. Central to this article is the focus on therapeutic process as a means to navigate beyond impasse. It is my hope that those who read this article will consider taking the risk to prioritise the therapeutic relationship, even when anxiety about ‘doing something’ to fix the problems is high.