Family Therapy Sessions Research Articles

Predictors of Outpatient and Inpatient Service Utilization Among Publicly-Insured Youth With Eating Disorders.

Although eating disorders (EDs) affect youth from all socioeconomic backgrounds, little is known about the treatment experiences of under-resourced youth with EDs. To address this gap, we examined patterns of outpatient and inpatient service utilization among publicly-insured youth with EDs in California and potential disparities for youth with additional marginalized identities. Participants were identified from the full sample of California Medicaid/Medi-Cal beneficiaries aged 7-18 with ≥ 1 service episode between January 1, 2014 and December 31, 2016. Claims data were extracted for youth with a full year of claims after the first known ED diagnosis (N = 3311) to analyze outpatient mental health, outpatient medical/physical, inpatient mental health, and inpatient medical/physical service use across ED diagnosis and demographic characteristics (sex, age, race/ethnicity, and preferred language). Outpatient individual and family therapy service utilization was low across ED diagnoses (4-7 individual therapy sessions and ≈5 family therapy sessions annually). Conversely, hospitalization rates were high, particularly among youth with anorexia nervosa (27.8%) and bulimia nervosa (30.0%). Youth with other specified feeding or ED had high medical service utilization, with more days of outpatient medical care and greater odds of medical hospitalization than youth with all other diagnoses. Latinx youth, Black youth, and boys tended to receive fewer services after accounting for diagnosis, with disparities particularly pronounced for Latinx youth. Publicly-insured youth with EDs in California experience high hospitalization rates but receive limited outpatient therapy. Additional research is needed to identify possible unmet needs and factors contributing to treatment disparities among these youth.

Effectiveness of Integrative Structural Family Therapy and Double ABCX Model on Marital Adjustment and Parenting Stress Among Parents of Children with Autism: Randomized Controlled Trial

Marital adjustment is an important predictor of coping with stress among parents of children with autism spectrum disorder (ASD). A randomized controlled trial conducted on 60 parents of children with ASD showed that integrative SFT and double ABCX therapy, conducted over ten sessions of multiple family therapy in group counseling for five weeks and a one-month follow-up at special needs children’s centers in Jordan, resulted in a 48% increase in marital adjustment and a 34% reduction in parenting stress. These therapies significantly improved the well-being of parents of children with autism, while the control group did not.

Актуальні напрями соціальної роботи з військовослужбовцями та їхніми сім’ями

Social workers play a critical role in providing support and guidance to military families during deployment. They offer counseling services to help family members cope with the emotional challenges of separation and uncertainty. By creating a safe space for families to express their fears and concerns, social workers can facilitate the healing process and strengthen family bonds. In addition, social workers play an important role in bridging the communication gap between deployed personnel and their families by ensuring that important messages and updates are effectively communicated. In addition, social workers connect military families with resources and support networks to help them navigate the challenges of deployment. Whether it's access to mental health services, financial aid programs, or educational resources for children, social workers advocate for the well-being of military families. In addition to the support provided by social workers, there are various programs and activities specifically designed to meet the needs of military families. Family therapy sessions are conducted to eliminate communication disorders and improve family relationships. These activities create a safe environment for family members to express their thoughts and feelings, ultimately fostering better understanding and cohesion.

Race/ethnicity and socioeconomic status as predictors of outcome following family therapy in youth at clinical high risk for psychosis.

There is limited research on the effects of sociodemographic and socioeconomic factors on treatment outcomes in youth at clinical high risk for psychosis (CHRp). This study examined sociodemographic factors that may affect functional outcomes within this population. Specifically, we investigated the influence of race/ethnicity (dichotomized as non-Hispanic whites [NHW] vs. people of colour [POC]), socioeconomic status (SES; operationalized as parental years of education), and their interaction on change in psychosocial functioning and symptoms over 6 months in a randomized trial of family-focused therapy. CHRp youth (N = 128) participated in a randomized trial of family therapy (18 sessions of family therapy vs. 3 sessions of family psychoeducation). Sixty-four participants who self-identified as POC and 64 self-identified NHW participants completed baseline and 6-month follow-up measures of positive and negative symptoms and psychosocial (global, role, and social) functioning. Multiple regression models were conducted to test the main effect of race/ethnicity on changes in positive and negative symptoms and functioning, and whether this effect was moderated by parental education. There was a significant interaction between race/ethnicity and parental education, such that higher parental education was associated with greater improvement in global functioning in NHW participants, but there was no relationship between parental education and global functioning in POC. Additionally, higher parental education was associated with a decrease in negative symptoms in NHW participants but not in POC. There were no significant effects of race/ethnicity or parental education on positive symptoms, nor on social or role functioning. Clinicians may consider tailoring psychosocial treatments according to the needs of diverse families who vary in sociodemographic factors such as educational attainment and race/ethnicity.

ENGAGING ADOLESCENTS IN FAMILY THERAPY: THE ROLE OF ENGLISH SLANG AND DIGITAL COMMUNICATION NORMS IN THERAPEUTIC SETTINGS

ABSTRACT
 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.
 Keywords: Adolescent, Family, Therapy, Slang, Digital, Communication, Norm, English.

Facilitating children's in-session involvement in child and family therapies: A dynamic framework of clinical practices.

Children's in-session involvement in child and family therapies correlates with both positive and negative treatment outcomes. Thus, it is important to gain a better understanding of the clinical practices that facilitate children's involvement in therapy sessions so that practitioners can employ them with greater precision. To address this need, we conducted a study to answer the following question: What clinical practices facilitate children's in-session involvement in child and family therapies? The data consisted of 16 extant audiovisual recordings of child and family therapy sessions and 24 stimulated-recall interviews with the participants in the recordings. Following constructivist grounded theory and incorporating storyline as an additional analytical technique, we have constructed a framework consisting of four involvement-enhancing practices: managing time, staying relevant, adjusting intensity, and facilitating inclusion. Furthermore, by detailing some of the complex processes that practitioners navigate when they facilitate children's involvement, our study adds a multilayered and dynamic dimension to the list of already established involvement facilitators. It may be used to moderate an overstandardized work culture that continues to characterize services that address children's needs. The results may be applied to other institutional encounters, providing resonance beyond the analyzed therapy sessions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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.

Doing mutual understanding in child and family therapy sessions: How three interlocutors calibrate new information

This paper presents an analysis of how three interlocutors sequentially organize and accomplish mutual understanding in naturally occurring audiovisual recordings of therapy sessions. The analysis is in keeping with microanalysis of face-to-face dialog (MFD) and follows operational definitions of three-step micro-processes that interlocutors use when they calibrate new information; that is, how they agree that they have understood each other’s words and actions well enough for current practical purposes. Pointing to some of the complexities that characterize triadic interactions, the analysis contributes with new documentations of ‘suspended’, ‘nested’, ‘branched’, ‘multi-paced’, and ‘mixed interpretations’ calibrations. The analysis also demonstrates how interlocutors may calibrate the ‘tone’ of an utterance before the topical content is mutually understood. The results and their implications may be relevant to practitioners of institutional talks at large, where the quality and outcome of, for instance, assessments and interventions largely rely on accomplishing mutual understanding.

The Ways of Overcoming the Impact of Graduation from School on the Mental State of Students and Their Parents: Counseling with a Social Worker to Solve Social and Psychological Problems

The study identifies and measures the emotional aspects affecting students’ learning and motivation as well as their relationship with the social and psychological environment in their family. Solving emotional problems was also one of the goals. In total, 50 schoolchildren, 16 to 18 years of age, took part in the experiment. Their parents also participated in the study for family therapy sessions. The experiment was conducted at Ajman Private School, Ajman Emirate, Ajman, United Arab Emirates. Prior to the study, graduates took a series of questionnaires to measure their emotional state. During the experiment, respondents had conversations with a social worker and an art therapist once a week. During conversations, a social worker helped the students and their parents to understand the difficulties in their relationships and to come to compromises. In art therapy sessions, respondents expressed their negative emotions on the canvas using art materials. The study lasted four months. Also, at the middle and end of the experiment, respondents took a series of tests to measure their progress over time. The outcomes demonstrated not only the interrelation of family support and emotional state but also the effectiveness of the chosen methodology. The average score on the Beck Depression Inventory prior to the study was 6.8 out of 10 points. On the Taylor’s Manifest Anxiety Scale, the average score was 7.4 points. According to the WAM test, the ‘wellbeing’ factor before the beginning of the experiment was equal to 4.9 points.

Walk‐in Together: A pilot study of a walk‐in online family therapy intervention

AbstractMany Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk‐in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof‐of‐concept study investigating the acceptability and short‐term effectiveness of an online walk‐in family therapy service, Walk‐in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk‐in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre‐session, post‐session, and at 6 weeks follow‐up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi‐structured interview data. Post‐session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post‐session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well‐received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk‐in delivery model. This proof‐of‐concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk‐in, telehealth model to meet the rising demand for therapeutic support for families in distress.

The Impact of Family Therapy Participation on Youths and Young Adult Engagement and Retention in a Telehealth Intensive Outpatient Program: Quality Improvement Analysis.

Early treatment dropout among youths and young adults (28%-75%) puts them at risk for poorer outcomes. Family engagement in treatment is linked to lower dropout and better attendance in outpatient, in-person treatment. However, this has not been studied in intensive or telehealth settings. We aimed to examine whether family members' participation in telehealth intensive outpatient (IOP) therapy for mental health disorders in youths and young adults is associated with patient's treatment engagement. A secondary aim was to assess demographic factors associated with family engagement in treatment. Data were collected from intake surveys, discharge outcome surveys, and administrative data for patients who attended a remote IOP for youths and young adults, nationwide. Data included 1487 patients who completed both intake and discharge surveys and either completed or disengaged from treatment between December 2020 and September 2022. Descriptive statistics were used to characterize the sample's baseline differences in demographics, engagement, and participation in family therapy. Mann-Whitney U and chi-square tests were used to explore differences in engagement and treatment completion between patients with and those without family therapy. Binomial regression was used to explore significant demographic predictors of family therapy participation and treatment completion. Patients with family therapy had significantly better engagement and treatment completion outcomes than clients with no family therapy. Youths and young adults with ≥1 family therapy session were significantly more likely to stay in treatment an average of 2 weeks longer (median 11 weeks vs 9 weeks) and to attend a higher percentage of IOP sessions (median 84.38% vs 75.00%). Patients with family therapy were more likely to complete treatment than clients with no family therapy (608/731, 83.2% vs 445/752, 59.2%; P<.001). Different demographic variables were associated with an increased likelihood of participating in family therapy, including younger age (odds ratio 1.3) and identifying as heterosexual (odds ratio 1.4). After controlling for demographic factors, family therapy remained a significant predictor of treatment completion, such that each family therapy session attended was associated with a 1.4-fold increase in the odds of completing treatment (95% CI 1.3-1.4). Youths and young adults whose families participate in any family therapy have lower dropout, greater length of stay, and higher treatment completion than those whose families do not participate in services in a remote IOP program. The findings of this quality improvement analysis are the first to establish a relationship between participation in family therapy and an increased engagement and retention in remote treatment for youths and young patients in IOP programing. Given the established importance of obtaining an adequate dosage of treatment, bolstering family therapy offerings is another tool that could contribute to the provision of care that better meets the needs of youths, young adults, and their families.

Learning from within: Therapists' actions in daily clinical practice.

The integration of theories and techniques is part of family therapists' daily practice, raising the need to understand which resources are used in this professional's clinical actions. Our aim is to reflect on the use of theoretical and technical resources by family therapists in their daily practice. We developed an inquiry process inspired by collaborative action research and social constructionism. Couple and family therapy sessions were conducted by two family therapists, and we developed subsequent dialogs with them focused on describing theoretical and technical inspirations for their actions. Next, we named four categories of actions in this process: exploratory actions, actions for the construction of relational visions, actions for the construction of communication, and actions for family orientation. The therapists-participants referred to many theoretical and technical resources that inspired their practice. For them, the choice of using one or another resource was based on the demands of the interactive moment, which involves their relational and embodied responses to what was experienced in the sessions. We argue that epistemological coherence is not something that guides the therapist's practice a priori, but something that can be achieved by talking about and reflecting on their actions. This article can contribute to clinical practice and training in family therapy by presenting an interesting reflexive process that can be useful to enhance practice in couple and family therapy (FAPESP, Process n. 2015/21316-1).

Comparison of the Effectiveness of Bowenian Family Therapy and Acceptance and Commitment-based Therapy (ACT) on Cognitive Emotion Regulation of Mothers with One Child

Aim: The aim of this study was to compare the effectiveness of Bowenian family therapy and acceptance and commitment therapy on the difficulty in regulating the emotion of mothers with one child. Methods: This was a descriptive quasi-experimental study with a pretest-posttest design with two experimental groups and a control group. The statistical population of the study included all mothers with only one child of preschool age in Kermanshah kindergartens in 2019. A total of 45 people were selected through convenience sampling and 15 people were randomly assigned to two experimental groups and one control group. Data were collected in the pretest-posttest stages with a scale of difficulty in emotion regulation (Grotz and Roemer, 2004). After pre-testing, members of the two experimental groups participated separately in eight 1.5-hour weekly sessions of Bowenian family therapy and acceptance and commitment therapy. Analysis of covariance and Bonferroni post-hoc test were used to analyze the data. Results: The results of analysis of covariance showed that the effect of Bowenian family therapy and the effect of acceptance and commitment based therapy on difficulty in emotion regulation in individuals is significant (P&lt;0.05). Also, differences in the two treatment groups for the dimensions of emotional rejection, difficulty in performing behavior, difficulty in controlling impulse, lack of emotional awareness, limited access, and lack of clarity, respectively, the amount of F statistic; 4.771, 4.461, 3.524, 3.399 and 5.720 with significant levels were 0.026, 0.005, 0.011, 0.001, 0.003 and 0.009, respectively. The results of Bowenian test showed that due to the size of the differences, the effectiveness of acceptance-based and commitment-based therapy in combining with other interventions on the difficulty of emotion regulation and its related components was higher (P &lt;0.05). Conclusion: Psychologists, when faced with problems of mother-child interaction, evaluate the mother in terms of the level of cognitive emotion regulation and other psychological variables affecting emotion regulation and use effective treatment methods if there is a problem.

Long-term follow-up of a randomized controlled trial comparing systemic family therapy (FT-S) added to treatment as usual (TAU) with TAU alone in adolescents with anorexia nervosa.

Randomized controlled trials showed the efficacy of family therapy for anorexia nervosa during adolescence, but studies examining its long-term beneficial effect are still needed. This article presents the results of a 54-month post-randomization follow-up of a previously reported randomized controlled trial that compared two post-hospitalization outpatient treatment programs: Treatment As Usual alone versus Systemic Family Therapy added to Treatment As Usual. A consecutive series of 60 female adolescents with anorexia nervosa (DSM-IV) were randomized (30 per group). During the first 18 months, in the Treatment As Usual group, subjects received a multidisciplinary treatment. In the other group, Systemic Family Therapy sessions targeting intra-familial dynamics were added to Treatment As Usual. At 54 months, the primary outcome was defined using the Morgan and Russell global Outcome Categories (Good or Intermediate versus Poor). Secondary outcomes were the Global Outcome Assessment Schedule score, body mass index, amenorrhea, number of hospitalizations, eating disorder symptoms, psychopathological features, and family functioning. Analyses were carried out using an Intention-To-Treat with the Last Observation Carried Forward procedure. Data of 59/60 subjects were available. At 54 months, significant effects in favor of adding Systemic Family Therapy to Treatment As Usual were shown for the Global Outcome Categories (60% of Good/Intermediate versus 31% in the control group, p = .026), mean body mass index (p = .048), resumption of menses (70.0% vs. 40% p = .020), and mental state score (p = .010). Family cohesion scores were lower in the Systemic Family Therapy group (p = .040). Adding Systemic Family Therapy focusing on intra-familial dynamics to a multidimensional outpatient treatment program appeared to lead to a better long-term outcome in young women who suffered from severe anorexia nervosa during adolescence.

Hypothyroidism Induced Mania: A Case Report

Hypothyroidism is associated with myriad of medical, neurological as well as psychiatric symptoms. There is classic association of depression with hypothyroidism and of mania occurring with hypothyroidism. Only few cases of mania associated with hypothyroidism are reported. This is the first case of mania associated with hypothyroidism in Nepalese patient. We report a case of 30-year-old female with symptoms of mania induced by primary hypothyroidism. She had no previous history of psychiatric disorder but her father was diagnosed depression. Psychosocial factors contributed to noncompliance of Tablet. Levo thyroxine. She was successfully managed with Tablet. Aripiprazole, thyroxine replacement, family therapy and psycho education sessions. Therefore, clinicians should be aware to assess thyroid function in patients presenting with mania, especially females with first episode. We should also evaluate for mania symptoms in cases of hypothyroidism. Psycho education of patient and family play vital role in the treatment process.

Recognising children’s involvement in child and family therapy sessions: A microanalysis of audiovisual recordings of actual practice

Abstract Children’s right to involvement in practices that address their well-being is frequently highlighted, yet how children exercise involvement in face-to-face encounters has remained fairly unknown. To fulfil our aim of identifying, describing and defining children’s involvement, we conducted an inductive microanalysis of face-to-face dialogue on audiovisual recordings of naturally occurring therapy sessions with children attending social services departments and mental health clinics. The resulting operationalisation generated six dimensions of children’s involvement: participatory, directive, positional, emotional, agentive and narrative. By operationalising how children exercise involvement, we render the abstract concept more amenable to fine-grained analysis, systematic evaluation and criticism. The domains also offer tools to recognise children’s involvement in practice. Lastly, the article discusses practical implications and presents a compass for orientation. Since many conversational elements in institutional talks are generic, the dimensions are potentially transferable to other settings, including school counselling, child protection investigation and clinical psychology. A high inter-analyst agreement, together with similar findings on utterance functions and interactional dominance in other types of dialogues, also enhance the dimensions’ transferability.

57.1 USE OF FAMILY THERAPY IN WORKING TOWARD FAMILY ACCEPTANCE WITH GENDER-DIVERSE YOUTH

Gender-diverse youth and their families are increasingly presenting to mental health settings beyond specialized gender clinics, yet clinical competence lacks among providers. Child and adolescent psychiatrists should understand the impact of family acceptance and rejection for these individuals and incorporate family therapy in the clinical setting when appropriate. Knowledge of the possible modifications from traditional family therapy interventions should be understood and applied. An overview of the clinical issues in treatment will be provided with a focus on transitional-age youth. We will also focus on the impacts of COVID-19 on gender-diverse youth and how telehealth has changed our work as child and adolescent psychiatrists. We aim to be interactive, with the use of case presentations, role-play, and/or a recording of a family therapy session. We will highlight complex family issues including religious or cultural barriers to family acceptance and the nuanced differences of working with adolescents vs young adults seeking gender-affirming treatment (medical transition). An ensuing discussion will synthesize the main topics and facilitate awareness of acceptance, rejection, stigmatized identities, and family dynamics in the clinical setting. Understanding family acceptance and rejection for gender-diverse youth is a treatment priority for clinicians. Incorporating family therapy interventions can enhance understanding, acceptance, well-being, and positive outcomes for gender-diverse youth from across the life span. Addressing these issues with clinicians enhances clinical competence in an area that has become increasingly more visible to the public yet remains underserved by child and adolescent mental health providers.

THE ROLE OF TRAIT FORGIVENESS IN MARITAL CONTENTMENT AMONG MARRIED COUPLES IN CITAM ASSEMBLIES, NAIROBI, KENYA

In most marriages, marital problems are encountered once in a while. Couples who have very happy marriages also encounter problems in their relationship with each other due to an offense committed by the spouse. For a couple to maintain a healthy marital relationship, they need to have the ability to forgive each other. Through forgiveness, married partners become more like Christ and invite the Holy Spirit to enable them to show their love for the spouse and build a safe and holy relationship that could bring contentment. The study examined the role of trait forgiveness in marital contentment among married men and women selected in two Christ Is the Answer Ministries (CITAM) assemblies in Nairobi, namely Woodley and Valley Road. The objectives of the study were to examine the role of trait forgiveness on marital contentment and to investigate how commitment, empathy, and communication affect the relationship between forgiveness and marital contentment. A mixed-methods design was used to collect data using questionnaires and a focus group discussion guide. Results showed a very strong positive correlation between trait forgiveness and marital contentment with a relatively high composite score being obtained for trait forgiveness. Results revealed themes of intimacy, patience, affirmation, self-control, reflection, and praying together on the moderating role of commitment, empathy, and communication. This calls for its magnification in both counseling practice and marriage and family therapy sessions as a sustainable antidote to marital contentment under relational stress, especially among Christian couples. Counseling practitioners should therefore emphasize the principle of forgiveness as the key to healing emotional wounds that are caused by offenses that manifest in the course of a marriage.

Explaining the facilitators of quality of life in patients with multiple sclerosis: a qualitative study

BackgroundIn patients with multiple sclerosis (MS), the disease’s complications and manifestations affect a person’s ability to function normally and leads to further disruptions in their education, family life, job opportunities, and daily life activities, thereby reduce their quality of life. Different factors as facilitators or inhibitors affect the quality of life in patients with MS. This study aimed to explain the facilitators of quality of life in patients with MS.MethodsThis research applied qualitative methodology, utilizing semi-structured interviews with individuals with MS and their family members/caregivers. Purposeful sampling was done among people who referred to Isfahan MS Association. Participants were selected with a maximum variation in terms of gender, age, education, occupation and marital status. Interviews were continued to reach data saturation. The gathered data were concurrently analyzed by the content analysis technique. MAXQDA software version 10 was used for data management.ResultsSaturation was reached after eighteen interviews. A total of three main categories and 8 sub-categories were extracted from the data. The identified facilitators were: personal facilitators (leisure time and coping strategies), interpersonal facilitators (exercise therapy, social support and social organizations) and needs and suggestions for improvement (family therapy, adopting urban architecture and facilities, and supportive systems).ConclusionsBased on these findings, in order to improve the quality of life in patients with MS, we should pay attention to factors such as leisure time, spirituality and positive thinking, exercise, social support and social organizations. Health professionals, the government, community and families could help to improve patients’ quality of life through adapting urban architecture, holding family therapy sessions and providing supportive systems.

Narrative therapy and the autism spectrum: A model for clinicians

Narrative therapy practices have a long history of application to a wide range of mental health conditions. This paper discusses a novel narrative approach specific to autism and the application of narrative therapy constructs for clinicians working with families who have a member with a diagnosis of autism spectrum brain style differences. The author introduces a visual framework and descriptive language as a reference point to think and talk about autism within the context of narrative family therapy. This framework guides clinicians toward supporting an individualized narrative of the pattern of strengths and differences that are part of the autism spectrum brain style. The narrative approach outlined in this paper provides the entry point for clinicians to guide families toward the development of strength-based narratives that foster connections and resiliency within the family. A narrative therapy model is introduced with three key features highlighted: structuring the session to accommodate for autism spectrum brain style differences, using descriptive language to support the development of alternative narratives, and highlighting key narrative shifts taken from family therapy sessions. Readers are provided with a case study that illustrates the use of narrative therapy structures when working with this unique population of families.