CONTEMPORARY FAMILY THERAPY

BIPOC Experiences of Racial Trauma on TikTok: A Qualitative Content Analysis
Hung YH, Miles A, Trevino Z, DAniello C, Wood H, Bishop A and Monshad Z
Racial trauma has long been an issue in American society. Recent incidents of racial violence, including the attack and murder of George Floyd and the rise of anti-Asian hate have garnered significant media attention. People often use social media to express their emotions and perspectives on national events, and it has become a popular forum for posting and commenting on content related to timely social issues. In effort to understand individual perspectives, and experiences of racial trauma discussed on social media, we analyzed content labeled with the hashtag "racial trauma" on TikTok during significant racial incidents from March 2020 to May 2022. Results of content analysis showed six themes, (1) encountering racism, (2) traumatic experiences, (3) consequences of experiencing racial trauma, (4) expressing difficult feelings, (5) questioning and challenging oppression, denial, and privilege, and (6) a call to action: raising awareness. Findings inform clinicians' understanding of how their clients experience racial trauma. Clinical implications for incorporating a nuanced understanding of racial trauma in mental health treatment are discussed.
Clinical Guidelines When Addressing Abuse over Telemental Health
Hoss L, Richardson LS, Axelrod AD and Cravens Pickens J
Providing therapy services via Telemental Health (TMH), or teletherapy, has exponentially increased since the COVID-19 pandemic. Although previous research demonstrates that TMH is as effective as in-person therapy, there is a dearth of research on how therapists should address technology-perpetrated abuse and intimate partner violence (IPV) over TMH. This is extremely problematic given the frequency in which violence occurs in romantic relationships. This manuscript aims to address this gap by providing concrete clinical guidelines based on existing literature and professional experience with engaging in TMH services. The authors review literature on technology-perpetrated abuse and discuss innovative ways to assess and treat IPV over TMH by adapting protocols from Domestic Violence-Focused Couple's Therapy. Within this, the authors integrate research on high-conflict couples to provide new suggestions on how to manage couples who escalate quickly and who are prone to violence. The manuscript will conclude with future directions for research.
The Impact of COVID-19 and Telehealth Services on Attrition Rates in Psychotherapy
Hellstern RB and Robinson WD
Attrition in psychotherapy has been identified as a significant obstacle in the productive delivery of mental health services. Defined generally as the ending of a treatment prior to proper optimal benefit, attrition both hinders treatment efficacy and costeffectiveness in therapy. With the demands for quality mental health services increasing, resources must be identified to reduce barriers to such services. The COVID-19 pandemic has resulted in the emergence of one potential resources: telehealth services. The current study aims to identify how COVID-19 and telehealth services have influenced attrition by analyzing attrition rates from both before and during the pandemic in a community health center where a transition to telehealth was made at the start of the pandemic. In addition, the variables of age, gender, socioeconomic status, and insurance coverage were also tested as potential predictors of attrition. Using de-identified patient information, clients who had participated in therapy services within a six-month period at a community health center (N = 329) were selected. A survival analysis was used to assess the time taken from initial appointment to the point of attrition. Results indicated that those who attended therapy via telehealth were less likely to stop attending treatment than those who participated in therapy in person. Individuals who used both in-person and telehealth visits were the least likely to terminate treatment prematurely. Clinical implications include the need for therapists to offer both telehealth and in-person services in order to give clients more resources to reduce a large barrier to needed mental healthcare treatment.
Meaning and Experience of International Migration in Black African South African Families
Mabandla N, Marchetti-Mercer MC and Human L
This article explores the experiences of some Black South African families affected by international migration. Historically, emigration from South Africa has occurred in waves, and has been associated with specific political moments. Such migration has often been perceived as a predominantly "White phenomenon", but recent trends reveal a more complex picture. Prior research on Black migration has focused primarily on internal labour migration, exilic migration and the "brain drain" phenomenon of medical professionals. So far, little research has been done on the impact of international outward migration on the Black family system. This article addresses this gap, drawing on a larger qualitative project exploring the impact of South African emigration on elderly family members staying behind. The findings highlight the significance of close relational ties in the Black South African family system. Familial separation through emigration brings feelings of loss and apprehension for the wellbeing of family members living abroad, including potential racism in destination countries. Migrants abroad highlighted the value of family and of maintaining a Black South African identity, despite separation from the country of origin and the extended family. Significantly, migration is often perceived as a temporary state, in contrast to White South African counterparts. Given increased international migration, the results shed light on the interplay between racial identity and emigration, and the impact of international migration by Black South Africans on family that they leave behind.
Time Spent Together in Intimate Relationships: Implications for Relationship Functioning
Hogan JN, Crenshaw AO, Baucom KJW and Baucom BRW
Current models of relationship functioning often emphasize conflict with a particular focus on the behaviors that occur in that context. Much less is known about the impact of time spent interacting in the absence of conflict. The primary aim of this study is to test associations between time spent in various forms of daily interaction (engaging in a shared activity, talking, and arguing) and multiple relationship outcomes while controlling for positive and negative communication during conflict. The present sample consists of 49 married couples ( = 98 individuals). Data were analyzed using multilevel models to account for non-independence of the data. Consistent with previous literature, communication behaviors were related to relationship outcomes. After controlling for communication, couples who spent more time arguing per day were less satisfied in their relationships, and perceived greater negative qualities in their relationships. Finally, couples who spend a larger proportion of their time together talking reported greater satisfaction, perceived more positive qualities in their relationships, and experienced greater closeness. These findings suggest that low salience interactions account for unique variance in relationship functioning above and beyond what is currently studied. Future research is needed to determine possible mechanisms by which low salience interactions are related to relationship outcomes.
The Cost of Cancer: The Association of Financial and Cancer-Related Stress on Maladaptive Coping Styles in Families with a Cancer Diagnosis
Johnson EM and Ross DB
According to the American Cancer Society (2020), it is estimated that 1.8 million new cancer diagnoses will occur in 2019 in the United States. Due to the frequency of cancer diagnoses and the increasing costs of treatment, financial stress is common among cancer patients. Guided by the Family Systems Illness Model (FSI), a cross-sectional study of individuals and family members where there was an active cancer diagnosis (n = 53) was conducted. The study utilized structural equation modeling to examine the impact of cancer stress and financial stress on maladaptive family coping mechanisms, and in turn, their effect on family communication and satisfaction. Findings indicate individuals with higher financial stress reported greater cancer stress. In turn, individuals with higher cancer stress, reported higher rigidity in their family coping which was associated with less family satisfaction. Additionally, as individuals reported greater family disengagement and chaos, lower levels of family communication and satisfaction were found. These findings provide evidence to the complex stresses experienced by cancer patients and their families. Therapeutic implications of how emotionally focused therapy may support these families dealing with a cancer diagnosis are discussed.
MedFTs' Role in the Recruitment and Retention of a Diverse Physician Population: A Conceptual Model
Davis CE, Lamson AL and Black KZ
Recruitment and retention of a diverse physician population across stages of medical education is essential for the success of the healthcare system. MedFTs have a unique role to play in advocacy and intervention related to the recruitment and retention of these physicians at all stages of their education and career. As MedFTs expand their influence in healthcare systems, they must ground into their fundamental theories, like systems theory and the Four World View, all while advancing in their professional competencies to attune their skills and those whom they are entrusted in training. The conceptual model, MedFTs' Role in the Recruitment and Retention of a Diverse Physician Population, provides a framework for MedFTs to use their influence to enact change related to diversity and equity in the healthcare system. In addition, the model provides avenues for intervention and advocacy on the part of the MedFT related to each of the four worlds and their specific role(s) in the health care.
Learning to Embody a Social Justice Perspective in Couple and Family Therapy: A Grounded Theory Analysis of MFTs in Training
Morrison T, Ferris Wayne M, Harrison T, Palmgren E and Knudson-Martin C
This action research study explores how four MFT students shifted from a cognitive understanding of equity and power to an intrinsic and automatic internalized process as we participated in research in which we observed, coded, and engaged in structured reflexive conversations about relational power using a data bank of Socio Emotional Relationship Therapy sessions. We reviewed and analyzed ten of our recorded two-hour reflexive conversations to develop grounded theory that explains our experience of learning to embody a relational power lens, which consists of five interconnected phases: (a) developing a theoretical understanding of relational power, (b) critically observing live therapy, (c) noticing and attending to the felt sense of witnessing power, (d) engaging in transformative conversation, and (e) applying to personal practice. Our findings provide guidance for clinical training programs who wish to facilitate the experience for clinicians-in-training to understand and address societal power processes in clinical practice.
Couple and family therapists' experiences with Telehealth during the COVID-19 pandemic: a phenomenological analysis
Orlowski EW, Friedlander ML, Megale A, Peterson EK and Anderson SR
In designing this study, we aimed to obtain a rich, phenomenological understanding of the experiences of couple and family therapists who transitioned their practice to telehealth due to the COVID-19 pandemic. Twelve experienced therapists from the U.S., Spain and Australia were interviewed in depth about their experiences of this transition, particularly how they developed and maintained therapeutic alliances in a virtual context with couples and families suffering pandemic-related hardships. The qualitative analysis identified 40 themes reflecting participants' initial impressions of telehealth and their positive and negative reactions and adjustments to practicing remotely. Upon overcoming some initial wariness about providing services virtually, many participants described advantages to this way of working with families. Indeed, participants were creative in adjusting to this novel therapy modality, finding new ways to connect emotionally with their clients, to work meaningfully with children, to assess in-session dynamics, and to ensure their clients' privacy and safety. Notably, several participants commented on the relatively slower development of alliances with new cases and the challenge of repairing split alliances between family members. Many of these difficulties were described as due to having minimal access to their clients' raw emotions and the inability to use typical systemic interventions, such as moving family members around physically. Participants also reflected on being a "participant observer" to the upheaval caused by the pandemic, a distressing experience they shared with the families in their care.
Learning About Parenting Together: A Programme to Support Parents with Inter-generational Concerns in Pune, India
de Wit EE, Adithy , Chakranarayan C, Bunders-Aelen JFG and Regeer BJ
Rapid developments in the last few decades have brought about dramatic changes in Indian social life, particularly affecting new middle-class families. Inter-generational conflicts, high academic pressures, and modern anxieties lead to stress both in parents and in children. There is a need for parenting programmes that respond to these specific concerns, in order to reduce parenting stress and improve family well-being. This study aimed to develop and evaluate a parenting programme in Pune, India, based on a 'theory of change'. In this pilot programme, parents were encouraged to learn in a group format about fostering autonomy in children, promoting academic potential in a stress-free manner and remaining in connection with adolescents. Facilitated by a psychologist, parents participated in four sessions involving 'creativity and play', 'self-awareness and bonding', and 'communication'. The intervention was based on validated psychotherapeutic approaches and parenting methods to support parents in their learning. Some 16 in-depth interviews were conducted with parents before and eight interviews after the intervention to understand their learning experiences. Additional feedback was gathered from observation notes and debriefings after each session. The results show that the attention for playful quality time helped parents to (re)gain a more creative and flexible attitude towards spending time with their children. Second, parents learned to reflect on their frameworks of meaning (rooted in their own upbringing), listen attentively and communicate more mindful with their children. Furthermore, this study shows that an activity-based approach, connecting parents in co-creating new parenting paradigms, while supporting them with stress-reducing tools, is a useful way of engaging this target group. The study concludes by offering new perspectives for counsellors working with families in countries undergoing rapid change.
Connected: Recommendations and Techniques in Order to Employ Internet Tools for the Enhancement of Online Therapeutic Relationships. Experiences from Italy
Manfrida G, Albertini V and Eisenberg E
The article explores the different types of therapeutic relationship that can evolve both on- and offline, thanks to the use of tools, such as software and applications, which enable therapists and patients contact outside of the traditional setting. Given the premise that it is practically impossible today to maintain a relationship without the use of internet and telephones, it becomes necessary to question the ways in which the online space can become a useful extension of the therapeutic setting. The authors, starting from a consideration regarding the specificity of the online therapeutic relationship, analyze the best ways to use text and email messaging with patients. Furthermore, specific interactions via group chats are presented, for example, to coordinate a therapeutic team involving several professionals. Further, video chat settings are discussed through a clinical case presentation. Lastly, the therapist's management of social networks is debated, underscoring the importance for the therapists that his or her online identity be consistent with the offline image which patients are introduced to in the traditional setting of the therapy room.
COVID-19 Inspired Relational Telemental Health Services for Incarcerated Individuals and Their Families
Tadros E, Aguirre N, Jensen S and Poehlmann-Tynan J
The novel coronavirus pandemic has caused marriage and family therapists (MFTs) to alter how they provide clinical services. MFTs must determine how to deliver relationship-oriented services to underserved populations that are often forgotten during crises, including incarcerated individuals and their families. The primary purpose of this paper is to showcase how relational telemental health (TMH) services for incarcerated individuals and their families can increase access to services and improve relational health. Information is presented about corrections in the U.S., effects of incarceration on partners, children, and other family members, the behavioral health and relationship needs of incarcerated individuals, and current approaches to relational mental health and telehealth in corrections. Finally, suggestions are offered on how relational TMH could be used in corrections during the COVID-19 pandemic, including advocacy for collaborative healthcare, recommended implementation practices, and ethical considerations.
Impact of COVID-19 on the Perinatal Period Through a Biopsychosocial Systemic Framework
Diamond RM, Brown KS and Miranda J
The perinatal period involves major developmental transitions which can be conceptualized through a biopsychosocial (BPS; Engel in Science 196:129-136, 1977, 10.1126/science.847460, in The American Journal of Psychiatry 137:535-544, 1980, 10.1176/ajp.137.5.535), systemic (von Bertalanffy, General system theory: Foundations, development, applications, George Braziller, New York, 1968) framework. Thus, no one domain of health in the perinatal period can be understood without exploring how the other domains are both impacted by and impacting the others. As a result of COVID-19, popular media is paying special attention to the biomedical domain of women in the perinatal period as it relates to health outcomes and changes in perinatal healthcare policies; however, considerably less attention is being paid to the other BPS health domains and systemic impacts. This paper will outline U.S. changes in healthcare as a result of the COVID-19 pandemic for individuals, couples, and families within the perinatal period (i.e., family planning and conception, prenatal, labor and delivery, and postpartum) and explore the unique psychosocial, systemic impacts. Recommendations for care, including telehealth and virtual support options, and future directions for research will be provided.
How Effective is Online Couple Relationship Education? A Systematic Meta-Content Review
Megale A, Peterson E and Friedlander ML
Due to logistical and financial barriers that keep many distressed couples from seeking psychotherapy, online relationship education is a more accessible alternative. In the decade since a web-based program showed equivalent effectiveness to traditional marriage education (Duncan et al., 2009), several fully online programs have been developed and evaluated. We reviewed nine studies of four different programs that sampled 2,000 + couples. Specifically, we rated each study's experimental rigor and compared research designs, theoretical and empirical grounding, average post-intervention and follow-up effect sizes, and differential effectiveness. Across studies, measured outcomes included relational (improved satisfaction, quality, confidence, commitment, communication; reduced conflict and aggression) and individual functioning on various indices of mental and physical health, emotional expression, and quality of life. Finally, we discuss the strengths and limitations of the research evidence, describe the two most evidence-based programs (ePREP and OurRelationship) in some detail and make recommendations for future study of these promising kinds of interventions.
Pre-Cohabitation Conversations for Relationships: Recommended Questions for Discussion
Brown KS, Schmidt B, Morrow C and Rougeaux-Burnes G
Moving in together is an important transition in a relationship. For many, it is often a shift to the next phase of the relationship indicating higher levels of commitment. Whether the partners are married, plans to get married, or marriage is not part of their future, there are important conversations to be had prior to this transition. As such, this article presents recommended pre-cohabitation conversations with question prompts for partners to explore prior to moving in together. To best understand the dynamics of cohabiting that informed the questions, a review of the literature on cohabitation is presented. Additionally, race and culture, religion, and sexual and gender identity will be highlighted as essential conversation considerations especially as the majority of the literature is centered around white, hetero, and monogamous relationships. Created by a group of couple and family therapy graduate trainees based on the literature and their own personal and professional experiences, the pre-cohabitation conversations are organized into three categories- relationship negotiations, household rules, and communication. These conversations are recommended to be used both by therapists with their clients as well as for direct use by partners following the questions presented within. The topics represent a comprehensive range of relationship issues including consideration of unique issues as presented in the literature with the goal of aiding partners in successful management of their transition to a shared living space.
Medical Family Therapy in Rural Community Health: A Longitudinal "Peek" into Integrated Care Successes
Lamson AL, Hodgson JL, Limon F and Feng C
Integrated behavioral health care (IBHC) continues to grow as an evidence-based service delivery model adopted by healthcare systems all over the world to better care for the holistic needs of patients and their families. Medical family therapy (MedFT), as a field, has offered innovation to IBHC models by delivering biopsychosocial-spiritual (BPS-S), relational, and family-oriented care across a variety of healthcare contexts. This article details a longitudinal review of a program, spanning 16 years, that grew from no behavioral health services to one that is highly integrated, and embeds MedFTs in a number of rural community health centers. This model highlights the importance of interdisciplinary teams, including Peek's clinical, operational, financial, and training worlds, as well as decision-making metrics for systems that predominately care for underserved and minoritized populations. The authors illustrate a framework for how the levels of primary care/behavioral healthcare collaboration relate to the work and practice of MedFTs as conceptualized through the MedFT Health Care Continuum and meet the BPS-S needs of diverse populations seeking pediatric, adult, and dental healthcare services. Also described are shifts made in the model over time based on (a) growth in cultural humility, (b) relationally-oriented practice, operations, finance, and training data, and (c) research informed decisions. Recommendations include ways MedFTs can facilitate provider and administrative buy-in, assess model fidelity, and strive for quality outcomes for patients.
Introduction to the Special Issue Health Care for All: The Role of Medical Family Therapy
Lamson AL, Mendenhall TJ, Hodgson JL and Bryant CM
Provider, Heal Thy System: An Examination of Institutionally Racist Healthcare Regulatory Practices and Structures
Roberts KM and Trejo AN
U.S. history is fraught with examples of systemic racism-at all ecological levels and within all geopolitical contexts. Whether scholars historically punctuate these phenomena through white racial framing begun in the 1600s or the Black civil rights movement of the 1960s, research across disciplines brings into focus a twenty-generation story of injustice. These phenomena present a paradoxical struggle within healthcare systems populated by professionals who have made a "conscious commitment to equity and helping those in need." However, both healthcare systems and embedded care providers operate in relation to organizational structures that frequently reify racist policies. As natural and professional agents of change, medical family therapists are especially positioned to examine how regulatory systems at every level influence institutional racism within the medical and mental health fields. In this manuscript we examine health system policies and practices using the lens of C.J. Peek's Four Worlds: Clinical, Operational, Financial, and Training. Examples of institutional racism are discussed and recommendations for approaches to change are provided.
National Guard Couples Communicating During Deployment: The Challenge of Effective Connection
Blow AJ, Farero AM, Ufer LG, Kees M and Guty D
Communication during a combat deployment has changed significantly in current times. Couples can now communicate with each other frequently and through multiple modes. Despite this greater availability of communication options, there remain unanswered questions related to how healthy deployment communication is best achieved between couples, particularly regarding navigating the uncertainty of deployment. In this qualitative study, we report on the experiences of 31 National Guard couples who endured a combat deployment in support of Operation Enduring Freedom. Couples were interviewed three months after the soldier returned from deployment. Through the lens of relational turbulence theory, we provide a conceptual framework related to effective and non-effective deployment communication, along with structural communication barriers in the military that may negatively affect the mental well-being of partners. Finally, we provide recommendations to guide couples through these difficult deployments.
Family-Centered Primary Care for Older Adults with Cognitive Impairment
Welch ML, Hodgson JL, Didericksen KW, Lamson AL and Forbes TH
Cognitive impairment (e.g. dementia) presents challenges for individuals, their families, and healthcare professionals alike. The primary care setting presents a unique opportunity to care for older adults living with cognitive impairment, who present with complex care needs that may benefit from a family-centered approach. This indepth systematic review was completed to address three aims: (a) identify the ways in which families of older-adult patients with cognitive impairment are engaged in primary care settings, (b) examine the outcomes of family engagement practices, and (c) organize and discuss the findings using CJ Peek's Three World View. Researchers searched PubMed, Embase, and PsycINFO databases through July 2019. The results included 22 articles out of 6743 identified in the initial search. Researchers provided a description of the emerging themes for each of the three aims. It revealed that family-centered care and family engagement yields promising results including improved health outcomes, quality care, patient experience, and caregiver satisfaction. Furthermore, it promotes and advances the core values of medical family therapy: agency and communion. This review also exposed the inconsistent application of family-centered practices and the need for improved interprofessional education of primary care providers to prepare multidisciplinary teams to deliver family-centered care. Utilizing the vision of Patient- and Family-Centered Care and the lens of the Three World View, this systematic review provides Medical Family Therapists, healthcare administrators, policy makers, educators, and clinicians with information related to family engagement and how it can be implemented and enhanced in the care of patients with cognitive impairment.
The Impostor Phenomenon in Mental Health Professionals: Relationships Among Compassion Fatigue, Burnout, and Compassion Satisfaction
Clark P, Holden C, Russell M and Downs H
Imposter phenomenon is defined as a sense of intellectual fraudulence and an inability to internalize success and competency. Although imposter phenomenon has been noted in several populations, literature is sparse that focuses on mental health professionals. In addition, little is known about the relationships between imposter phenomenon, compassion fatigue, and compassion satisfaction for mental health workers. Using a survey design with a convenience sample of 158 mental health workers, this study found that imposter phenomenon was positively associated with compassion fatigue, as well as negatively associated with compassion satisfaction, when controlling for years of work and age. Further, the combination of lower levels of compassion satisfaction and higher levels of burnout predicted higher levels of imposter phenomenon. Implications and preventative measures are discussed.
The Therapeutic Alliance with Parents and their Children Working Through a Relational Trauma in the Family
Gilson ML and Abela A
This study is about how a therapeutic alliance is created and maintained with parents and their children working through a relational trauma. A case study design with narrative analysis as a method of research (Riessman, 2008) and a narrative approach of storying stories, inspired by McCormack (2000), is used. The participants of this study are the parents and their four children, aged between 14 and 5 years, and their systemic therapist. Rich data on the therapeutic alliance is gathered through, two live-family session observations and seven interviews, six of which were with the family members, and a two-part interview held with their therapist. Results show that the way of being of the therapist, including her ability to be intuitive and self-reflexive, and her ability to keep manoeuvrability in conversation and hold neutrality support her to connect with all the family. Creating conjoint and separate therapeutic spaces, using a creative play-based approach and navigating an alliance with the school and medical professionals, were important suggestions for practice in the field. Additionally, collaborating with parents, and balancing the benefits and drawbacks of involving children to make therapy meaningful for all, are also suggested. Specific recommendations for engagement with siblings of the identified-problem child are elicited. The strength of this study is that children's voices, along with those of their parents' and their systemic therapist are reported. Suggestions for practice to support children and their families who are working through a relational trauma are brought forward.
Cultivating the Therapeutic Alliance in a Telemental Health Setting
Glass VQ and Bickler A
Telemental health services have broadened during the last decade (Choi et al. 2019; Pierce et al. 2020). More recently, Severe Acute Respiratory Syndrome Coronavirus 2019 (COVID-19) restrictions have led to an escalation in clinical services through telemental health settings. The purpose of this phenomenological study was to consider perspectives of Marriage and Family Therapists (MFT)s who are working in telemental health settings prior to and/or as a result of COVID-19 restrictions and consider the role that telemental health has in building therapeutic connections with clients. Researchers presented an online survey that explored participants' perceptions of providing telemental health. Participants included 23 MFTs who were currently licensed or working under an MFT supervisor. Data analysis uncovered the following thematic responses: (a) doing telemental health is similar, but different, than in-person therapy, (b) adapting to telemental health is worthwhile, and (c) validating clients' voices and experiences is fundamental to building an alliance in telemental health therapy. Findings supported the importance of further training in telemental health, specifically related to cultural humility and alliance building within telemental health settings.
Virtual Family Play Therapy: A Clinician's Guide to using Directed Family Play Therapy in Telemental Health
Smith T, Norton AM and Marroquin L
The field of marriage and family therapy was founded by innovators and pioneers, taking the practice of individual psychotherapy and making it systemic. Due to the impact of COVID-19, we now need further advancement by systemic therapists for telemental health services. The purpose of this paper is to propose recommendations and guidelines for adapting directed family play therapy from the same physical location services to telemental health. The article discusses recommendations for assessment, therapy structure, therapist roles, session preparation, and how to use virtual tools to enhance treatment. Systemic play therapy in a virtual format can work well if therapists make appropriate adjustments and rely on their creativity, high regard for ethics, and innovation.
Much More Than PTSD: Mothers' Narratives of the Impact of Trauma on Child Survivors and Their Families
Coulter S and Mooney S
This study examined the narratives of ten Caucasian mothers whose children had been impacted by 'traumatic' events and referred to a specialist trauma service in N. Ireland. The research question was whether the PTSD construct adequately represented the broad 'lived' experience of the impact of trauma on survivors' wellbeing and their family relationships as articulated by mothers post trauma. Narrative Interviewing methodology was employed and the resulting data inductively organised into an evolving thematic framework. A quantitative analysis of the prevalence of particular themes is presented supplemented by qualitative quotations to illustrate the complexity of reported impact. The major components of the mothers' narratives included family and relational distress (35.7%), non-pathological individual distress (24.4%), resilience (16.7%) and a prior history of adversity (16.6%). Prior history of adversity was resent in 8 out the 10 cases including a high level of suicide. PTSD symptomatology constituted a small proportion of the narratives (6.6%) and this suggests that the PTSD construct does not adequately represent the broad 'lived' experience of the impact of trauma. Although a small and heterogeneous study sample, the findings are sufficiently robust to suggest further investigation is required to understand the phenomenological experience of trauma of child victims/survivors and their families.
Are Perfectionistic Standards Associated with Burnout? Multidimensional Perfectionism and Compassion Experiences Among Professional MFTs
Holden CL and Jeanfreau MM
The current study addressed the role that perfectionism plays among professionals in this field of marriage and family therapy (MFT). Specifically, this study provides information about PS (personal standards) perfectionism and EC (evaluative concerns) and their relationship with both compassion satisfaction and compassion fatigue. The sample included 247 marriage and family therapists who answered demographic questions along with completing the professional quality of life scale (ProQOL; as reported by Stamm, B. H. (2009). Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (ProQOL). Retrieved from http://www.proqol.org/ProQol_Test.html; Stamm in The concise ProQOL manual, ProQOL.org, 2010;) and the multidimensional perfectionism scale (MPS; Hewitt and Flett, Journal of Personality and Social Psychology 60:456-470, 1991). Results indicated three significant findings: (1) higher levels of both self-oriented and socially oriented perfectionism are correlated with higher levels of both burnout and secondary traumatic stress; (2) as years of work as an MFT increase, level of burnout decreases; and (3) women demonstrated statistically significantly higher scores in PS perfectionism than men. Limitations, implications, and future directions are discussed.
Exploring the Relationship Balance Assessment
Luttrell TB, Distelberg B, Wilson C, Knudson-Martin C and Moline M
Assessments of power in couples' relationships often only survey one partner, but they do not take into consideration both partners' perceptions. Thus, many assumptions about power and equality in relationships have not been quantitatively tested due to a lack of dyadic measures of power. Therefore, the purpose of the Gender and Relationships Study was to develop and test a new scale of equality and relative power for couples, the Relationship Balance Assessment (RBA). The RBA may be useful for research and for clinical work with couples to help raise awareness of the balance of power in their relationship. A review of the literature has shown a shift away from focusing on monetary resources and decision-making dominance towards examining relationship processes and the connection between gender and power. This study prescreened a pool of process-oriented questions based on the qualitative literature. Then exploratory factor analysis of data from 268 individuals and 91 couples identified 12 consistent latent factors underlying relationship equality. These 12 subscales are summed up with the TREASURES acronym: Time Discretion, Relational Power, Emotional Power (Emotional Expression and Avoidance subscales), Accommodation, Spending and Saving subscales, Union or Sexual Dominance, Rational Power, Economic Role Power (Status and Childcare subscales), and Social Choices.
Solution Focused Brief Therapy Telemental Health Suicide Intervention
Finlayson BT, Jones E and Pickens JC
One of the innumerable impacts of the coronavirus has been the change in how individuals provide services. For mental health providers, the pandemic required a sudden shift from in person to online service delivery. As therapists learn and embrace a new modality for providing therapy, crisis situations may present with some anxiety. With the pandemic increasing crisis situations for so many individuals, and teletherapy as a mode of service delivery being unlikely to go away after the pandemic, therapists require support in navigating crises situations online, in a medium that feels like the therapist has less control with their clients due to being in different physical locations. The authors believe that regardless of the primary model(s) therapists utilize in session, solution-focused brief therapy is an integrative model that uniquely captures client's resources and reasons for living and when clients are in crisis. The purpose of this paper is to present recommendations for applying solution-focused language in teletherapy practice, to provide ethical, evidenced based care for clients in crisis. A clinical vignette is used to illustrate the application of solution focused brief therapy for working with clients in crisis. Future directions and limitations are discussed.
Clinical Consultation as a Family Intervention in Residential Treatment: Exploring What Impacts Outcomes
McConnell C and Taglione P
The Relational Re-enactment Systems Approach to Treatment model is an approach to residential treatment that embraces the need for family involvement through clinical consultation. Clinical consultation is a systems-oriented family intervention that embodies the model's principles regarding therapeutic alliance and working through ambivalence. Families engage with treatment providers and other collaterals in an ongoing process of developing goals, creating a shared understanding of the youth, and working toward discharge. The current study explored youth characteristics and outcomes. Additionally, the investigation included comparisons between youth with and without the involvement of the Department of Children and Family Services in terms of length of stay, involvement in consultation, and sustained outcomes. Finally, therapists who work with youth and their families discussed their understanding of what differentiated successful and unsuccessful cases.
Intentionality in Academic Telesupervision: A Phenomenological Study of Faculty Telesupervisors' Experiences
Schmittel EM, Lettenberger-Klein C, Oliver T, Butterfras RF and Adamson DW
In response to the COVID-19 pandemic and a widespread shift to telehealth, there is an increased need to understand how we can best provide Telesupervision (TS). To help address the limited research on TS in the Marriage and family therapy (MFT) field, the present study seeks to describe the experiences of faculty telesupervisors who have provided TS as part of an online COAMFTE Accredited MFT master's program since 2012 (telesupervision was provided before accreditation since 2005). Eighteen participants completed individual interviews or focus groups, which were analyzed using descriptive phenomenological procedures. Our results describe the essential structure of faculty supervisors' experiences providing TS. Core themes include: general experiences with TS as a modality, online university-specific experiences with TS as a modality, a systemic lens is intentionally applied, diversity, equity, and inclusion (DEI) are intentionally addressed, and clinical competencies and ethics are intentionally addressed. A discussion of the essential experiences of faculty TS along with implications for clinical training and future research are reviewed.