Family Therapy Research Research Articles

Including the infant in family therapy and systemic practice: charting a new frontier

AbstractThis position paper from a core group of infant mental health academics and clinicians addresses the conspicuous underrepresentation of the infant in mainstream family therapy. Despite infants' social capacities and clear contributions to family dynamics, they remain largely overlooked within this therapeutic context. We suggest that family therapists have moral and professional responsibilities to support the participation, protection, and well‐being of all family members, including the infant. Here, we emphasise the importance of including the infant in the family therapy setting. By highlighting their frequent omission, we aim to amplify infants' often unheard ‘voice,’ role, and contributions to family development, especially recovery from distress. A shift towards infant inclusion as the rule rather than the exception represents a new frontier of integration. We first highlight the relational nature of infant development with a focus on the infants' psychosocial capacities and vulnerabilities. We then consider reasons why the infant may be overlooked in family and systemic therapies and offer a rationale for inviting the infant into these settings, illustrated through the use of a clinical case vignette. To facilitate infant inclusion, we propose a series of guidelines to meaningfully incorporate infants into family therapy practices. We conclude by encouraging shifts in family therapy research, training, and practice to better incorporate and understand the unique contributions of the infant to family life.

Researching what we practice-The paradigm of systemic family research: Part 2.

This is the second of two articles focusing on ideological and philosophical preferences for relating to and conducting research in the field of systemic couple and family therapy (CFT). To emphasize the need for the field of systemic CFT to be based on the best available knowledge, in the first article, we argue the benefits of applying the principles of evidence-based practice, and in the current article, we present the rationale behind the contents of a program for systemic family therapy research that safeguards methodological multiplicity. The need for multi-methodological systemic research is also recognized on the basis of the authors' self-reflexive accounts of overcoming barriers to learning skills and deepening their understanding of quantitative methods. We thus argue that trans-methodological reflexivity is necessary and we argue a preference for methodological multiplicity that includes statistical competency as regards the interdependence of observations (i.e., nonindependence), and we further argue that these are crucial components of a systemic research program.

State of research in MFT: Thoughts from the Editor's Chair: This article is a modified transcript of the keynote address given by Dr. Steven M. Harris, Editor of the Journal of Marital and Family Therapy, at the inaugural annual meeting of the Intervention Research Topical Interest Network of the American Association for Marriage and Family Therapy. The meeting was held

The Editor of JMFT discusses the state of research in systemic family therapy.

Creating a Holistic Model of Heterosexual Marriage Wellbeing Mechanisms

The links between marital relationship well-being and multiple life outcomes, including health, finances, career, living conditions, and happiness, are repetitively endorsed in academic studies. These outcomes are far-reaching and broadly representative, so it is perhaps surprising that there are limited publicly available, evidence-based models of marital wellbeing mechanisms to aid couples in trouble or to educate families, professional helpers, or policy makers in their decision-making processes. The goal of this study was to isolate the generic properties of marital health and understand their operation - investigating the precedents, antecedents and maintenance of adult romantic relationship happiness, stability and general marital well-being, including how these constructs self-organise and co-relate, how outcomes emerge, and how we might therefore potentially alter these outcomes. Over the last 40 years thousands of studies have been carried out to determine the factors that contribute to marital satisfaction and endurance. Nonetheless, to this point in history little has been done to synthesise these multiple factors into an overarching model of marital wellbeing. For this study, pre-existing theories and research findings pertinent to marriage and relationships were sought out using a scoping review, collating more than 24,000 research articles. The multi-grounding process extricated categories from the scoping review for the model development. Prominent pertinent theories were discovered, and their premises were explored, compared, and inter-relationships were considered in the model development process. Given the prevalence and primacy of marriage partnerships across most societies and given the individual importance and the societal impact that these partnerships have, this model has significance for individuals, therapists, family therapy lecturers and researchers, policy makers and even societal and business leaders.

The refused interpretation in Freud, Jung and beyond: what if the patient says "no".

The paper attempts to illustrate how refusing an interpretation can lead to very different consequences within Freudian, Jungian, and other psychotherapeutic models. In some cases, a "no" may refute the model of reference, while in others it may have less radical meanings. Refusing an interpretation (if it is consistent with the model and the patient's history) within a Freudian environment can also challenge the validity of the model. From a Jungian perspective, a refusal may simply lead the therapist to change the model of reference, since no single model is considered universally valid. Other examples are also provided from the psychoanalytic, cognitive-behavior, and family therapy research traditions.

Cross‐cultural validation of the Turkish version of SCORE‐15

AbstractThe purpose of the current study was to examine the validity and reliability of the fifteen‐item Systemic Clinical Outcome and Routine Evaluation (SCORE‐15) Turkish version. The suggested three‐factor structure was confirmed with a total sample of 327 participants including both community and clinical samples. The results of factorial invariance tests demonstrated that the structure of the scale was consistent across both gender and community/clinical groups. Furthermore, discriminant validity was supported by negative correlations with marital satisfaction, life satisfaction and general family functioning as lower scores in SCORE‐15 reflect better adjustment. Furthermore, results showed that SCORE‐15 has good internal consistency reliability and significantly differentiates between community and clinical samples. Overall, these findings indicate that the Turkish version of SCORE‐15 is a valid and reliable instrument that can be used for assessing family functioning in routine clinical practice and family therapy research. Practitioner points SCORE‐15 is a brief and effective instrument for assessing overall family functioning with specific dimensions of family strengths, communication and difficulties The Turkish version of SCORE‐15 exhibited similar factorial properties across gender and community/clinical groups The Turkish version of SCORE‐15 can be used in both clinical and community contexts for research and intervention

Lost in Translation: Applying Principles of Translational Science to Systemic Family Therapy Research

Translational science has specific stages outlined by the National Institute of Health. Systemic family therapy (SFT) researchers do not seem to explicitly embrace this paradigm, though many are actively adding to the discipline’s empirically supported intervention base. We discuss the role of translational science in the landscape of SFT research. We report the findings of a case study review of a year’s worth of SFT scholarship. We make recommendations on how researchers can use this paradigm to help practitioners better understand the limits of applying research findings in their clinical practice, and provide recommendations for how to write clinical implications sections.

Expanding our international reach: Trends in the development of systemic family therapy training and implementation in Africa.

Family therapy is growing around the world including in many parts of Africa. Although the African continent has many mental and family health needs that family therapists are well-suited to treat, barriers to the widespread application of family therapy on the African continent remain. In this article, we review the current state of systemic family therapy (SFT) in Africa. Drawing from existing literature, we discuss past, current, and future trends, including challenges related to the training and implementation of SFT in Africa. We devote sections of this article to discussing the historical and cultural context, including the fit for family therapy, along with ongoing initiatives in various African countries, using examples from three African countries. We emphasize and discuss the influence of Western models of family therapy in informing family therapy research, training, and implementation in Africa and discuss implications for the African context.

Representation of Diverse Populations in Couple and Family Therapy Intervention Studies: A Systematic Review of Race/Ethnicity, Sexual Orientation, Age, and Income in the United States from 2014 to 2019.

Disparities in mental health care among marginalized populations have been well-documented. Without research designed to study interventions for diverse populations, disparities in the quality of services will persist. A systematic review of articles evaluating couple and family therapy (CFT) interventions was conducted to evaluate the representation of diverse populations. More specifically, researchers sought to examine race/ethnicity, sexual orientation, income level, and age of sample participants. One hundred ninety-six studies evaluating CFT interventions in the United States in ten journals were included in the analysis. Findings indicate that family therapy research is more representative of racial minority and low-income participants compared with studies of couple interventions. Couple therapy research is often still conducted with predominately white, middle- to high-income samples. Following whites, African Americans and Hispanic/Latinos were the most common racial/ethnic groups included in both couple therapy research and family therapy research. Participants in same-sex relationships were absent from family intervention research and under-researched in couple intervention studies. Only one couple therapy study recruited a sample in which the average age was late adulthood. These findings are cause for concern given the widening mental health disparities in the United States.

The Mother‐in‐Law Mystique: A Tale of Conflict, Criticism and Resistance

While women have been described in various disciplines as the kin keepers of family relationships, empirical data show that the greatest rivalry in newly constructed heterosexual families exists between two women: the mother‐in‐law and the daughter‐in‐law. Numerous rituals are employed across cultures in order to ease the expected tension between these two rival women. Yet, the topic seems to have been overlooked by feminist and family therapy research alike. Inspired by Bowen's (1978) concept of differentiation of self and Linn's (1998) and Gilligan's (Linn & Gilligan, 1990) ideas of the resisting self, the present study examines these female rivals as moral critics in the war zone of the family. The study sample consists of 14 mothers‐in‐law, daughters‐in‐law, and sons/husbands, belonging to five Israeli families of diverse cultural origin. Gilligan's Listening Guide was used to assess how participants saw the dilemmas of their situation, adopted a critical distance, and formed an authoritative moral voice.

An Introduction and Illustration of Bayesian Modeling in Couple and Family Therapy Research.

Bayesian modeling is becoming increasing popular as a method for data analyses in the social sciences and can move couple, marriage, and family therapy (C/MFT) research forward. Bayesian modeling helps researchers better understand the uncertainty of findings and incorporate previous research into analyses. Other benefits of Bayesian modeling are the straightforward interpretation of findings, high-quality inferences even with small samples (in combination with an informative prior), and the ability to work with complex data structures (observations nested in relationships and time points) which are common in C/MFT research. This article introduces the benefits of Bayesian modeling and provides an example of an Actor-Partner Interdependence Model using R. Information on how to conduct the same analyses using Stata and MPlus is provided in the Supplemental Information.

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.

A 20-Year Review of Common Factors Research in Marriage and Family Therapy: A Mixed Methods Content Analysis.

Introduced by Sprenkle, Blow & Dickey (1999), common factors in marriage and family therapy (MFT) have been discussed over the past two decades. Although the MFT common factors literature has grown, there are misconceptions and disagreements about their role in theory, practice, research, and training. This content analysis examined the contributions of the common factors paradigm to MFT theory, practice, research, and training over the past 20years. We identified 37 scholarly works including peer-reviewed journal articles, books, and chapters. Using mixed methods content analysis, we analyze and synthesize the contributions of this literature in terms of theoretical development about therapeutic effectiveness in MFT, MFT training, research, and practice. We provide commentary on the substantive contributions that the common factors paradigm has made to these areas, and we discuss the implications and limitations of the common factors literature, and provide recommendations for moving common factors research forward.

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.

Addressing Immigration-Related Stress in a Culturally Adapted Parenting Intervention for Mexican-Origin Immigrants: Initial Positive Effects and Key Areas of Improvement.

Culturally adapted evidence-based parenting interventions constitute a key strategy to reduce widespread mental health disparities experienced by Latinx populations throughout the United States. Most recently, the relevance of culturally adapted parenting interventions has become more prominent as vulnerable Latinx populations are exposed to considerable contextual stressors resulting from an increasingly anti-immigration climate in the country. The current study was embedded within a larger NIMH-funded investigation, aimed at contrasting the differential impact of two culturally adapted versions of the evidence-based parenting intervention known as GenerationPMTO©. Specifically, a sample of low-income Mexican-origin immigrants was exposed either to a culturally adapted version of GenerationPMTO primarily focused on parent training components, or to an enhanced culturally adapted version in which parenting components were complemented by sessions focused on immigration-related challenges. The sample for the study consisted of 103 Mexican-origin immigrant families (190 individual parents). Descriptive analysis and generalized estimating equations (GEEs) indicated that exposure to the enhanced intervention, which included context- and culture-specific sessions, resulted in specific benefits for parents. However, the magnitude of the impact was not uniform for mothers and fathers and differed according to the type of immigration-related stress being examined (i.e., intrafamilial vs. extrafamilial stress). Overall, findings indicate the relevance of overtly addressing contextual (e.g., discrimination) and cultural challenges in culturally adapted interventions, as well as the need to increase precision according to the extent to which immigration-related stressors impact immigrant mothers and fathers in common and contrasting ways. Implications for family therapy practice and research are discussed.

Systemic family therapy integrated with attachment interventions for adoptive families. Development of a treatment manual

Manualisation, although to some extent controversial, is an essential requirement for outcome research in family therapy. No manuals are available for therapy of adoptive families. This paper presents the development of a manual of a therapy model with adoptive families, based on the integration of a systems approach and attachment theory. We describe the background and process of development of the manual conducted in collaboration by clinicians and a research team. Twenty‐nine core elements of the model were identified and operationally defined by a focus group of clinicians. All elements except one showed good interrater reliability. The manual provides a tool to address the treatment of adopted families. Since the support to adoptive parents using a family therapy approach remains an under‐researched area, a manual available to clinicians and researchers will promote outcome studies in this area and training of therapists working with adoptive families.Practitioner points Adoptive parents often need help to form secure attachment bonds with their adopted children A manual for family therapy targeted at adoptive families has been developed The manual presents a model integrating attachment based interventions within a systemic framework

Children, Separation, and Divorce: Legal, Facilitative and Family Therapy Interventions and Research

Children, Separation, and Divorce: Legal, Facilitative and Family Therapy Interventions and Research

A Narrative Expansion of Emotionally Focused Therapy With Intercultural Couples

Intercultural relationships continue to rise in the United States, while the fields of couple and family therapy research lag in their inclusion of diverse samples that best reflect these relationship realities. Emotionally focused therapy (EFT) is an empirically supported approach to working with couples that offers promise for working with intercultural couples. In this article, we first review clinical considerations when working with intercultural couples and then discuss how therapists can expand EFT using narrative techniques to ensure the realities intercultural couples face are included in the therapeutic process. We conclude with specific suggestions for working with intercultural couples.

Strengthening Clinical Research in Marriage and Family Therapy: Challenges and Multilevel Solutions.

There is a critical need for high-quality and accessible treatments to improve mental health. Yet, there are indications that the research being conducted by contemporary marriage and family therapy (MFT) scholars focuses less on advancing and disseminating clinical interventions than in previous decades. In this article, we describe challenges to increasing rigorous clinical research in MFT. We use systems mapping and the intervention-level framework to identify strategic goals designed to drive innovation in clinical research in the field. It is our hope this article encourages dialog and action among MFT stakeholder groups to support clinical science that will improve the health and functioning of families.

Reflecting on the Past: A Content Analysis of Family Therapy Research from 2000-2015.

In this content analysis, researchers examine articles published from 2000 to 2015 in three family therapy journals, yielding a total of 948 empirical articles. The purpose is to provide an overview of the research being published, assess who is publishing, and investigate the current state of clinical effectiveness research in marriage and family therapy (MFT). Most first authors were affiliated with MFT programs and primarily included diversity and couples in their research. There was a significant increase of research on clinical process-though the number of clinical outcome studies held steady. There were no significant changes with regard to research funding. Implications support the use of innovative research methods to provide evidence of clinical effectiveness.