Family Therapy Practice Research Articles

“There Is No Such Thing as Neutrality”: An Interview with Dr. Carmen Knudson-Martin, Ph.D. on Feminism in Academia/Clinical Practice

ABSTRACT Dr. Knudson-Martin is a prolific researcher, educator, presenter, editor, and clinician in feminist family therapy, currently serving as Professor Emerita at Lewis & Clark College. Her work includes over 100 publications (books, book chapters, and refereed articles) and over 120 professional presentations (invited and refereed). Accolades include recognition as one of the most influential papers published in the Journal of Marital and Family Therapy (1975–2011), the Anselm Strauss Award (with Dana Matta) for Best Family Qualitative Research (2007), and the Distinguished Contribution to Family Therapy Theory and Practice Award from American Family Therapy Academy (2017). Along with Douglas Huenergardt and a clinical research team, Dr. Knudson-Martin, founded Socio-Emotional Relationship Therapy (SERT), which focuses on the intersection of emotion, power, and sociocultural contexts in the micro-processes of couple interactions. This interview focused candidly on how Dr. Knudson-Martin’s understanding of feminism changed over the years, her views on barriers faced by feminist researchers, and the strong influence collaborative relationships in academia have had on her career. Contextualizing her evolved understanding of feminism, Dr. Knudson-Martin reflected on her past research that divided the concept of gender into three elements (power, culture, and process) and how her own privilege initially restricted her understanding of feminism. Finally, Dr. Knudson-Martin highlighted the importance of working across disciplines to broaden perspectives, bridge theoretical divides, and begin with an intersectional lens rather than secondary consideration of identity as “an add-on.”

“Feminism is Intersectional”: Interview with Evan Imber-Black, PhD on Feminism and Marriage and Family Therapy

ABSTRACT Evan Imber-Black, Ph.D. is a prominent figure and has made major contributions in the field of family therapy since the 1980s. Currently, she serves as a Professor and the Program Director of the MFT Program at Mercy College in Dobbs Ferry, New York. Dr. Imber-Black is internationally recognized for her scholarly commitment to systemic research and therapy. She served as editor-in-chief of Family Process and has authored many original papers and books that have influenced models of practice, including family rituals and family secrets. Dr. Imber-Black’s career demonstrates the power of leadership in family therapy, and that within this field one can succeed and impact families through all sectors of systemic therapy: clinical practice, research, teaching, and mentorship. This interview explored the history of a powerful woman who rose to the ranks of a boy’s club in the MFT field and discusses the gender and racial/ethnic disparities within the field today. She shared her perspective of intersectionality in contemporary feminist family therapy practice and education.

Building a Medical Family: Family Sculpting in Graduate Medical Education

Introduction: Family sculpting has been used as a clinical technique for decades within the psychotherapy community to uncover, process, and improve upon the implicit patterns of interaction and communication that permeate the lives of family members. However, even though this technique has been broadly applied to various couple and family populations within the clinical practice of family therapy, its application has essentially been non-existent outside of this venue.
 Method: The following article describes the utilization of family sculpting as a bonding technique for a group of family medicine and clinical pharmacy residents, faculty physicians, and upper administration during a yearly organizational retreat.
 Results: Not only was the technique well received by the healthcare team as a whole, as evidenced by a post retreat survey, there were also several noteworthy examples of the sculpting process highlighting and addressing relational tension within the residency cohort (i.e., second year medical resident) and within administration (i.e., chief executive officer) that ultimately lead to greater team cohesion afterwards.
 Discussion: While the application of the technique in a medical/educational context can be considered a unique contribution of the article, more so are the specific augmentations made to the technique itself that increases its value as an academic and organizational development tool.

Using ROM in family therapy.

Routine outcome monitoring (ROM) is in this article defined as a tool for feedback-informed therapy where clients' therapy relevant information is applied in real-time therapy. Because family therapy represents a comprehensive clinical setting, ROM is experienced as particularly useful. In a vignette from family therapy practice, the use of ROM is demonstrated on individual, couple, and family levels with reference to integrative systemic therapy. ROM information is shown to play a central role in the different phases of treatment. It is demonstrated how ROM facilitates patient-centered assessment that strengthens the therapeutic collaboration such as the working alliance, identifying treatment targets, and possible constraints. In particular, ROM revealing alliance rupture followed by alliance repair is emphasized as a crucial therapeutic event in this treatment.

Changing Family Styles in China: The Influence of Traditional Media and Internet Use on the Acceptance of Premarital Cohabitation

This study aims to explore the relationship between media use and Chinese residents’ attitudes toward acceptance of premarital cohabitation (AAPC). We collected data from a national Chinese survey (N = 10,968). The results demonstrated that greater traditional media use was associated with worse AAPC, whereas Internet use was associated with better AAPC. We also found that individualistic orientation could mediate the relationship between traditional media and Internet use and AAPC. Traditional gender role beliefs showed disparate moderating roles in the influence of traditional media and internet use on AAPC. The implications for family therapy practice were discussed.

Integrative Practice in Family Therapy

Integrative Practice in Family Therapy

Talking about race, culture and racism in family therapy

AbstractFamily therapy practice in the UK, as elsewhere in the world, takes place within the context of structural and systemic racism. Hence the practice of family therapy has the potential to mirror racist and colonialist tropes found within society. There are low levels of satisfaction by people from Black and ethnic minority backgrounds to the level of sensitivity to culture and racism that takes place in therapy. This paper explores ways a systemic psychotherapy might be more sensitive to differences in race and culture. Drawing upon systemic and anthropological constructions of culture, suggestions are made for practice that is more questioning of the barely conscious or unconscious assumptions made by the therapist, which can then lead to open scrutiny of these assumptions. In doing so, I draw upon my own experiences, and those of my own family, of racism, of culture and of movement across cultures. Practitioner points Structural racism in society will find its way into the therapy room unless therapists are open to an examination of their own prejudices and often unconscious assumptions. Such an examination then opens the way to forms of practice that are more sensitive to differences of race and culture. A form of practice more sensitive to race and culture is proposed as a systemic response to racism, whilst keeping in mind the need for change at a social and political level.

26.3 “WE'RE ALL WALKING ON EGGSHELLS!” FAMILY THERAPY INTERVENTIONS TO RESOLVE MEDIA-RELATED CONFLICTS

Objectives: Child and adolescent psychiatrists often hear parents lament that their child is on a screen too much. This can be disruptive to the family and can displace other important activities for the child, such as schoolwork, sleep, or exercise. The lines are blurred now more than ever, in the context of COVID-19, when screens are necessary for remote learning and for peer socialization. For some families, navigating screen limits becomes an ongoing and recurrent conflict leading to everyone feeling like they are “walking on eggshells.” This presentation will focus on the application of family therapy concepts to working with families around negotiating media rules. Methods: Key concepts, largely from narrative and attachment-focused family therapy theories, will be described. These will include the importance of joining with each member of the family and defining the problem in systemic terms such that all members recognize their contribution to sustaining and maintaining the problem and their role in improving it. Ensuring that all parties, including the child, have buy-in to work on the problem is important. Recognizing problematic patterns in families (such as the parent nagging/child withdrawing, parent overfunctioning/child underfunctioning) will be described. Language to externalize the problem, or to look at the problem as located within the system and not within the child, will be offered. Focusing on improving attachment relationships within the family, which are often frayed in the context of these recurrent conflicts around media, will be reviewed. Results: Concepts from the family therapy literature and practice will be highlighted. These concepts can be easily incorporated into the practice of child and adolescent psychiatrists. Conclusions: Child and adolescent psychiatrists are well poised to help families navigate conflicts and negotiate limits around screen use. Collaborative ways to engage the child and family in shifting problematic patterns can improve family relationships and communications. FT, FAM, MED

ممارسة العلاج الأسری فی خدمة الفرد فى تنمیة الوعى الأسری للشباب المقبل على الزواج

ملخص البحث هدفت هذه الدراسة إلى محاولة التحقق من مدى فاعلية برنامج للتدخل المهني في اطار العلاج الأسري في خدمة الفرد لتنمية الوعي الأسري للشباب المقبل علي الزواج . واعتمدت الدراسة على مقياس الوعي الأسري للشباب المقبل علي الزواج الذي أعدته الباحثة والمقابلات الفردية والجماعية مع أعضاء المجموعة التجربية. والدراسة من النوع التجريبي وذلک عن طريق التجربة القبلية ـ البعدية بإستخدام مجموعتين احداهما تجريبية والأخرى ضابطة تشمل کل مجموعة (15) مفردات من الذين تنطبق عليهم شروط العينة من الشباب المقبل علي الزواج بالمعهد العالي للخدمة الاجتماعية بالمنصورة. وتوصلت نتائج الدراسة الي أن هناک فروق معنوية ذات دلالة إحصائية بين متوسطات درجات التطبيقين القبلي والبعدي لمقياس الوعي الأسري للشباب المقبل علي الزواج عند مستوى معنوية (0.01) لصالح التطبيق البعدي. مما يشير إلى التأثير الإيجابي لبرنامج التدخل المهني في اطار اطار العلاج الأسري في خدمة الفرد لتنمية الوعي الأسري للشباب المقبل علي الزواج الکلمات المفتاحية : العلاج الأسري – الوعي الأسري – الزواج- الشباب Abstract The practice of family therapy in the case work for developing family awareness for youth entering marriage This study aimed to try to verify the effectiveness of a professional intervention program within the family therapy in the case work for developing family awareness for youth entering marriage. The study was based on the measure of family awareness for young people coming to marriage prepared by the researcher and individual and group interviews with members of the experimental group. The study is of the experimental type, through the pre-post experiment using two groups, one experimental and the other controlling. Each group includes (15) vocabulary from those who meet the conditions of the sample of young people coming to marry at the Higher Institute of Social work in Mansoura. The results of the study concluded that there are statistically significant significant differences between the averages of the scores for the pre and post application of the measure of family awareness for young people coming to marriage at a significant level (0.01) in favor of the post application. This indicates the positive impact of the professional intervention program within The practice of family therapy in the case work for developing family awareness for youth entering marriage. Key words ; family therapy- family awareness- marriage- youth.

Authority in therapeutic interaction: A conversation analytic study.

A paradigmatic shift toward postmodern, collaborative practice in family therapy raises questions about how therapists can use professional authority to facilitate change and how clients can assert their knowledge and agency. We used conversation analysis to investigate how the authority to know and to determine here-and-now action (i.e., who does what, and how, in therapy) was negotiated and accomplished in 10 sessions of emotion-focused therapy involving chair work. Therapists were observed to rely on a particular interactional sequence structure: stepwise entry into a directive, in which directives were preceded by a question-answer sequence. We show how instances where clients' views were elicited prior to the delivery of a directive resulted in different interactional consequences from instances where therapists straightforwardly directed clients to perform some action. The study offers evidence concerning how therapists can facilitate chair work collaboratively and responsively.

'Living in a Zoom world': Survey mapping how COVID-19 is changing family therapy practice in the UK.

Following the COVID‐19 pandemic, psychological therapies rapidly moved online in mid‐2020. The Association for Family Therapy and Systemic Practice in the UK (AFT) surveyed the attitudes and practices of systemic therapists in the UK in early October 2020, exploring members’ views and gathered information about ongoing needs. A sample of 312 people were included in a mixed methods analysis. In total, 65% of respondents felt their overall experience of using online video technology professionally was positive, further reflected in responses to two open‐ended questions. Detailed thematic analysis revealed that many positive comments were related to the practical advantages of online working, whilst many negative comments were related to technique and the therapeutic relationship. Possible respondent biases are discussed, and the implications of this change in practice are explored. It remains to be seen if this marks the beginning of a more permanent shift in our field as we explore the potential of new technologies.Practitioner Points The vast majority of UK systemic therapists felt that their experience of online video technology was positive.They noted many practical advantages but also identified many challenges regarding therapeutic techniques and the therapeutic relationship.Therapists developed a range of creative solutions to maximise the therapeutic opportunities of online video.

A family systems approach to genetic counseling: Development of narrative interventions.

To what extent are family systems approaches relevant in the genomics era? What difference does it make to remember the wider social context within which ‘problems’ associated with a genetic diagnosis reside? How does this influence the conversations we have with our patients? These questions will be considered in relation to systemic approaches to genetic counseling practice. Narrative therapy with an emphasis on people's strengths, wishes, and ways of resisting the effects of a problem may be a particularly useful framework for genetic counselors. Narrative practice views people as multi‐storied and is concerned with the question of how we encourage people to tell their stories in ways that make them feel stronger. Increased uptake of genomic testing and the number of people seeking genetic counseling present opportunities to consider new ways of working, particularly around support following a new genetic diagnosis. One option is to realize the potential of group interventions. Family therapy and narrative practices have the potential to encourage communication and for families to learn from each other.

The Dual Process of Intuitive Responsivity and Reflective Self-supervision: About the Therapist in Family Therapy Practice.

Psychotherapy research shows that-in individual therapy as in family therapy-some therapists are more effective than others. This highlights the crucial role the therapist plays in a client's improvement. Furthermore, it seems that training may make a difference, as deliberate practice can improve the therapist's effectiveness. In the context of the current renewed awareness of the importance of the person of the therapist in the psychotherapy field, this paper's focus is specifically on the therapist in family therapy practice. There is a long tradition of reflecting on the person of the therapist in the family therapy field, often inspired by the metaphor of the wounded healer. In contrast, focusing on the person op the therapist in the present moment of the therapy session is fairly new. In this paper, we use of the dual process models from cognitive psychology as a frame to reflect on the person of the therapist. We review these dual process models and propose that the intuitive responsivity of the therapist relies on the fast, implicit cognitive system (system 1) and the therapist's self-reflection on the slow, deliberate system (system 2). The therapist's actions in therapy practice then emerge moment-by-moment as an echo of the way these two cognitive systems balance each other. It is optimal if the therapist, attuned to the family's rhythm, can flexibly oscillate between the two systems. In the concluding comments of this paper, reflective questions are posed about what this perspective may mean for family therapy practice, training, and supervision.

Reviewing the Social GRACES: What Do They Add and Limit in Systemic Thinking and Practice?

The Social Graces framework is increasingly used within training institutions, as a means of encouraging learners to critically explore issues of social difference. Attending to issues of power and diversity is believed to help trainee family therapists become more alert to any biases that may impact on therapy. This review paper draws on the developing literature to examine what the social graces add and limit in systemic thinking and practice. It also considers an alternative approach for exploring power and difference in family therapy practice.

The Systemic Assessment Clinic, a Novel Method for Assessing Patients in General\xa0Adult Psychiatry: Presentation and Preliminary Service Evaluation

The traditional model of psychiatric assessment and diagnosis can be criticised as reductive. We developed an innovative model for psychiatric assessment of adult patients referred to our adult mental health team, the Systemic Assessment Clinic, incorporating the principles and techniques of systemic family therapy and dialogical practice into standard psychiatric assessment. We conducted a service evaluation, comparing prospective use of mental health services for patients assessed either in the Systemic Assessment Clinic or in standard assessment. Patients assessed in the Systemic Assessment Clinic had more favourable outcomes than those in standard assessment: they were significantly less likely to need multiple follow-up treatment appointments with a psychiatrist and to be re-referred to mental health services once discharged, indicating reduced healthcare costs. Satisfaction rates for participants attending the systemic assessment clinic were high. Our service evaluation gives preliminary evidence that the Systemic Assessment Clinic could be a potential new model for psychiatric assessment; further evaluation is warranted in a randomised controlled trial.

Freedom and struggling openly in psychotherapy: A qualitative inquiry with LGBQ young adults from religious families.

Lesbian, gay, bisexual, and queer (LGBQ) young people from religious families are at increased risk of family rejection, poor mental health outcomes, and are overrepresented in mental health services. This article describes a two-part qualitative study aimed at exploring the experiences of LGBQ young adults from religious families in psychotherapy, identifying positive and negative psychotherapy experiences, and understanding the influence of family and religion on the psychotherapy experience. Data were collected through a web-based survey (n=77) and interviews (n=7) with LGBQ young adults (ages 18-25) from religious families. The study followed an interpretative phenomenological approach. Integrated results found often invisible, relational therapy processes, and religious discourses as significant to LGBQ young people who seek psychotherapy. Implications for future research, effective systemic family therapy practices with LGBQ young people from religious families, and a critique on ethical and legal limits of confidentiality with policy implications are outlined.

Spirituality – a forgotten dimension? Developing spiritual literacy in family therapy practice

Spirituality is hard to approach and define in family therapy practice, both as a concept and as a process. Spiritual perspectives are seen as important in an ecological understanding of family life, yet there is a research gap in the field of family therapy. The research reported here set out to explore the experience of spirituality from the perspective of family members and family therapists in therapeutic practice in Norway. Using a grounded theory methodology, we developed a middle range theory of spiritual literacy for family therapy practice. Although we offer no solutions to the dilemmas and hesitations experienced around the possible silencing of spiritual matters in family therapy, we make some recommendations for training and supervision practices.Practitioner points Spiritual experiences can be difficult to approach and define in family therapy Lack of recognition of spirituality in training and in practice seems to make therapists hesitant Encourage training programmes to open discussions about spirituality Be open to spiritual issues in supervisor training and practice

Arlene Vetere og Jim Sheehan (red.): Supervision of Family Therapy and Systemic Practice

Arlene Vetere og Jim Sheehan (red.): Supervision of Family Therapy and Systemic Practice

‘Can I tell?’ Children’s participation and positioning in a secretive atmosphere in family therapy

As a multifaceted phenomenon, family secrets affect interaction in the therapeutic system. This qualitative study, applying the multi‐actor Dialogical Methods for Investigations of Happening of Change, explored how children participated and positioned themselves in family therapy in a climate of family secrets. The results showed that the children were active co‐participants in the complex dynamics of a secretive atmosphere, involving themselves in the paradoxical processes of reconstructing and deconstructing the secretive and unsafe climate. In family therapy, a child’s symptomatic behaviour can function as a visible ‘cover story’ for invisible constructions of secrets, preventing sensitive topics from becoming the focus of therapy. Family secrets therefore continue to present a challenge in family therapy practice and research.Practitioner points Family secrets should be asked about in pre‐therapy assessment and diagnostic interviews where all family members are present The genogram enables the exploration of multigenerational family patterns and functions that might be influenced by family secrets By normalising the phenomenon of family secrets, therapists could make room for joint discussions on these and encourage family members to talk about their good reasons for keeping secrets

Can Spiritual Ecograms be Utilized in Mental Health Services to Promote Culturally Appropriate Family and Couples Therapy with Indigenous People?

Research addressing the potential utilization of spiritual ecograms with Indigenous families and children, specified by experienced professional in the field of Native-American psychology, was critiqued and reviewed in order to attend to its influence and applicability regarding the literature of Indigenous family therapy, and how it could be beneficial in therapy with Indigenous families. The literature review presents an effective tool, providing an in-depth exploration of spiritual strengths of the family and or children that incorporates spirituality into techniques commonly used in family therapy practice. Study results (Limb & Hodge, 2011) show that this tool is consistent with Native-American culture (Brucker & Perry, 1998; Green, 2010; Paniagua, 2005; Trujillo, 2000) and highlights many beneficial qualities for its utilization in practice. Limitations and recommendations for future research are also discussed.