Therapy models developed for Western nations are being imported into Cambodia, yet there is limited research on the effectiveness or native experiences of these therapeutic practices. We present a responsive evaluation of Cambodian therapists’ perspectives regarding the use of Western-based therapy models. Utilizing responsive evaluation methodology, qualitative data were triangulated across multiple stakeholders (N = 95) and multiple methods. Results indicated that, regardless of preferred model, using Western-based therapy presents challenges at individual, family, agency, community, and cultural levels. Participants emphasized that for imported therapeutic models to be culturally responsive and have acceptance and impact in Cambodia, the challenges within Cambodia’s mental health field must first be considered.
In couple's therapy, secrets between the couple often arise, and couple's therapists must navigate a balance between their ethical and therapeutic responsibilities. This paper provides a scoping review of the literature on how couple's therapists handle secrets in the context of couple's therapy and discusses the ethical and clinical considerations in the context of the ethical standards of the AAMFT. Online databases were used to systematically identify peer-reviewed academic, English-language articles that focused on recommendations for therapists in handling secrets between couples in therapy. Seven articles met the search criteria. The empirical evidence supports a model of professional judgment, whereby the therapist can use their discretion about whether or not to disclose a secret on behalf of a client. To operate within the confines of ethical practice, we recommend therapists pair professional judgment with a clearly informed and signed written client policy.
The 2020 COVID-19 pandemic and resulting stay at home orders halted face-to-face in-home therapy for youth at risk of out-of-home placement in Pennsylvania and Delaware. Three family therapy training centers collaborated with state officials managed care organizations, and supervisors to create a two-step process for orchestrating an abrupt, unwanted shift to technology-assisted intensive in-home family therapy. The first step encouraged supervisors to set the stage for this change through an ethics-based lens. The central tenet was to tenaciously advance the wellbeing of the child and their family. The second step encouraged supervisors to remain grounded in the basic principles of treatment and supervision that they followed before telehealth, but with a few adaptations. Three principles are emphasized. Principle one focused on securing clinician commitment to a adapting a family therapy model to a telehealth format. Principle two focused on an unremitting adherence to a preferred family therapy model by using a checklist adapted for technology-based challenges. Finally, principle three focused on fostering professional competence through attending to case conceptualization, supervision-based practice, person-of-the-self challenges, and family-clinician-supervisor isomorphic patterns. Two case examples illustrate the beginning and ending phases of technology-assisted intensive in-home family therapy. Based on feedback from in-home agencies, implementation of these two-steps helped supervisors effectively lead pandemic-induced, practice-based change to a telehealth format with intentionality, conviction, and self-efficacy.
The IPscope (IP signifying Interpersonal Patterns), developed at the Calgary Family Therapy Center by Karl Tomm and colleagues, provides a way of understanding behavior in context. Building on our work using the IPscope to conceptualize the functioning of families, we have also used the IPscope to bring a relational ethos to CFT supervision. After describing the development of the IPscope and its use at the CFTC, we describe specific applications of the IPscope to several key foci of clinical supervision: cross-cultural issues; the supervisory working alliance, with specific reference to supervisee nondisclosure and informal supervision; supporting supervisees to develop case conceptualization skills with the IPscopic reflectogram; dealing with impasses in therapy or supervision, usually labeled intrapsychically as countertransference, and a practical approach to isomorphism. Finally, we address limitations and critique of the IPscope.
ABSTRACT Pregnancy loss is a traumatic event that affects many families. 1 in 5 pregnancies end in miscarriage, and 1–2 out of every 100 births are stillbirths. Mothers report depression, shame, and guilt following a pregnancy loss. They also report a lack of social and emotional support, as Western culture tends to discourage mothers from grieving. Additionally, the impact on partners often goes unnoticed, as pregnancy loss is primarily framed as a birth parent’s issue. As couples struggle to deal with the emotions of pregnancy loss, many approach the process of grieving in ways that inhibit healing, which can negatively impact their relationship. Given the potential difficulties, many couples seek therapy to help them with the challenges that may follow pregnancy loss. However, there is a lack of literature that discusses how to systemically treat pregnancy loss. This article aims to address that gap by presenting a narrative approach to treating pregnancy loss. Narrative therapy is a natural fit when treating grieving couples as it allows them to coauthor their story of loss and coauthor a story of healing. Narrative therapy provides a space for couples to share their story, externalize problems related to the loss, find unique outcomes to support an alternative story, and solidify a new narrative related to their pregnancy loss.
This special issue of the Journal of Family Psychotherapy was initially conceived at the 2019 World Family Therapy Congress sponsored by the International Family Therapy Association (IFTA) in Aberd...
Online telesupervision (OTS) is synchronous (real-time) audio and video interactions between a supervisor and a clinician who are not in the same physical location. The COVID-19 pandemic created an abrupt pivot to OTS, requiring systemic supervisors and clinicians to adopt and utilize technologies which were unfamiliar to many. To facilitate the effective adoption and implementation of OTS we draw attention to three distinct competencies critical to the effective use of OTS: technological, contextual, and relational. These competencies are in no way exhaustive but lay the ground work for systemic supervisors to engage and connect with supervisees using video conferencing technology. In addition to the competencies, specific techniques and strategies are suggested to assist supervisors hone their skills in OTS and subsequently improve the quality and effectiveness of supervision in a virtual environment.
This paper provides a description of an integrative model of systemic and psychodramatic supervision practice; conceptualizing and illustrating the clinical use of time, space, and action within supervision. By introducing specific supervisory skills and key principles, the authors propose that in addition to language, action within supervision can support clinicians to become creative and responsive whilst remaining clear and rigorous in their practice. Rather than seeing the integration of disciplines as novel, the authors remind us that the schools of psychodrama and systemic therapy have shared roots and through the use of a supervisory exercise, demonstrate that these ideas have the potential to further cross-fertilize and enhance techniques for supervision and therapy practice.
Despite evidence of the importance of self-of-the-therapist factors for positive clinical outcomes, supervisors interested in helping their supervisees enhance their therapeutic effectiveness by honing their use of self may not have the framework to guide this process. In this article, we present the Person-of-the-Therapist Training (POTT) as a model that offers a clear philosophical perspective and specific tools to incorporate self of the therapist work in supervision. We start with a general introduction to POTT, its philosophical underpinnings, and its main concepts. Then, we describe the POTT supervision goals and specific emphasis. Subsequently, we present two POTT instruments (signature theme and case presentations and papers). With a vignette, we illustrate the use of the two instruments and show how this work on the person of the supervisee translates into the supervisee's clinical work with their clients. Specific recommendations about the implementation of POTT supervision are also included.
Researchers used thematic analysis to identify participant perceptions of the alignment between their faith traditions and family systems theory, structural family therapy, Bowen’s multigenerational theory, and narrative family therapy. Thirty-seven participants from six faith orientations, including 20 denominations or sects, responded to a survey. Patterns across responses indicate that family systems theory concepts are compatible across diverse faith traditions. Structural family therapy’s emphasis on restructuring boundaries and hierarchy is compatible across faith traditions as long as cultural and religious norms are carefully considered. Bowen’s concepts of detriangulation and differentiation are compatible across faith traditions, but particular beliefs may contradict the transmission of family patterns. Core concepts of narrative family therapy are compatible across faith traditions as long as therapists honor intuitive processes, include stories from clients’ faith traditions, and do not instill stories of false hope. Regardless of model, some clients may resist definitions of psychological dysfunction and understand illness and change as supernatural.
In Turkey, conflicts with parents-in-law can be shaped by opposing viewpoints that can emerge from the coexistence of modern secular and Islamic traditions. The integral role of parents-in-law in Turkish families makes it important to understand the nature of conflict between couples and their in-laws, and how these conflicts are managed. Guided by structural family theory, this preliminary study aims to explore the nature and management of conflict between parents-in-law and couples. This interpretive phenomenological study analyzed semi-structured interviews conducted with four Turkish couples. Conflicts with parents-in-law appeared to be gendered in nature and stemmed from unmet expectations and family roles. Gender also influenced how conflict was resolved. Daughters-in-law tended to avoid conflict by remaining silent, and sons-in-law were more forthcoming about their dissatisfactions or took the blame to avoid conflict. In-laws of opposite sex appeared to have more contemptuous relationships compared to in-laws of the same sex. Implications for clinical work and research are discussed.
While systemic thinking permeates the fields of couple, family, behavioral, ecological, medical, government, business and political sciences, appreciation of the implications of fundamental presuppositions can be obscured with the passage of time, the emergence and resurgence of alternative approaches. Previously unpublished documents preserved in the Don D. Jackson Archive, will be used as points of reference to discuss elemental presuppositions of the MRI Interactional View from which much of current day systemic practice derive.
Millions of mixed-status Latinx immigrant families in the United States are facing extreme stress and fear of family separation stemming from harsh immigration enforcement practices. In this paper, we suggest that true systemic practice involves knowledge and critical engagement with the broader contexts of families' lives. To this end, we review the history of immigration policy that created today's sociopolitical climate and help therapists situate themselves within this larger context. We then offer additional practice considerations for family therapy with mixed-status families, ranging from pre-intake concerns to community and advocacy work. Our hope is that therapists will use the areas of this paper that best fit their own practices and contexts, with the shared goal of providing ethical and just services to undocumented and mixed-status Latinx immigrant families.
In Japan, there is no evidence-based intervention for parents with mental illness that is designed to support the patient in parenting and to prevent disorders in their children. The aim of this study was to evaluate the safety, feasibility and perceived benefits of using the Let's Talk About Children program from Finland for parents with mood disorders in Japan before carrying out a more formal clinical trial. Nine parents with mood disorders whose children were aged 8-16 years old without a history of mental illness participated in the program. The Let's Talk About Children program was carried out between a researcher/practitioner and participants during a preliminary discussion and two discussions. The program was conducted with a 1-week to 1-month interval between discussion one and discussion two. All participants completed the intervention, and interventions were conducted with fidelity. In terms of intervention safety, no one reported a harmful experience, and the participants reported considerable benefits from the intervention. Most parents reported that their well-being and self-acceptance changed positively. Parents reported more confidence in parenting and fewer worries about their children. All participants reported that their treatment motivation was positively changed and that they had experienced the intervention as very helpful or useful. The results are consistent with those in a corresponding Finnish study. The results suggest that the Let's Talk About Children program is feasible for use with Japanese parents with mood disorders, and a clinical trial can be recommended.
Predictors of success and process of change research studies on Emotionally Focused Couples Therapy (EFT) have identified three active ingredients that are central to the success of EFT: Task alliance, experiential depth, and affiliative interactions. The goal of this paper is to provide concrete meaning to what the subtle details of the EFT process research findings look like in practice, in order to provide a process roadmap for implementing these key ingredients of change. Typically, process research describes processes that are important for the successful implementation of a therapeutic approach without delineating the specific meaning of these processes in concrete clinical terms. We elaborate on how the ingredients of change are defined and measured in process research studies. Exploring the specific elements of these active ingredients further illuminates their concrete meaning in everyday practice through specific interventions. We conclude with a clinical case example to illustrate following the process roadmap.
This article discusses unique considerations for a culturally sensitive emotionally focused therapy (EFT) for African American couples. EFT is an empirically supported treatment that significantly reduces relationship distress, yet efficacy with diverse populations remains unknown. African Americans' chronic exposure to racism and discrimination creates a cumulative racial stress that negatively impacts their couple relationships. We propose a racially sensitive intervention for African American couples that addresses five considerations most salient for successful EFT treatment: the impact of racial stress, client trust of the therapist, gender-role expectations, and racial-gender views of emotionality and vulnerability. A case study illustrates this approach.
Burnout is a significant challenge for helping professionals, and several unique factors make MFTs in agency settings particularly vulnerable to experiencing burnout. We identified key factors from the existing literature related to MFTs' experiences of burnout in agency settings. To provide an updated snapshot of this phenomenon, we also surveyed 140 MFTs using the Counselor Burnout Inventory. Based on the accumulated evidence and our supplementary findings, we propose three categories of strategies for MFTs in agency settings to prevent and cope with burnout. Given that identifying burnout and finding effective remedies require not an either/or but rather a both/and solution, we also discuss how supervisors, training programs, and agencies can help clinicians manage and confront this issue.
This focus group study explores the experiences of five partners of patients suffering from obsessive-compulsive disorder concerning how this disorder might influence couples' relationships in the long-term. We find that the disorder might give rise to power struggles concerning "normality", deprive couples of opportunities for rewarding fellowship during household chores and leisure time, and persistent analytic processes concerning predicaments of what to do. They also express a need for more help from the health services. The results might be of value to therapists in their daily work, and might have implications for future research on couple's therapy involving this group.
Noted first is a growing tendency of marriage and family therapists (MFTs) to create and describe approaches that, although labeled as systemic, are built on the language and concepts of classical psychodynamic therapy. Next a brief description of the history and evolution of a systems theoretical perspective is followed by an enumeration of many of the basic beliefs and behaviors we suggest MFT students in training need to understand and be able to utilize with clients. Given the complexity involved with teaching systems theory, particularly at the level of second-order cybernetics, several strategies to facilitate student learning also are provided.
During the Khmer Rouge reign in Cambodia from 1975 to1979, approximately one-quarter of the country's population lost their lives by starvation, disease, or execution. Most intellectual and academic institutions, including mental health services, were destroyed during this period by the Khmer Rouge regime who saw them as a threat. About 15 years ago mental health services began to be reinitiated in the country, usually in collaboration with Western academics and mental health experts. The call for these services was often in response to the high prevalence of post-traumatic stress disorders and other psychosocial problems. Today mental health issues still receive insufficient attention in Cambodia, mainly stemming from a lack of resources, knowledge about the general topic of mental health, and stigma. This article presents the results of a survey delivered to the first generation of psychology students since the end of the Khmer Rouge regime regarding their impressions of the current mental health needs in Cambodia. Respondents answered questions about the types of problems people bring to Cambodian counselors and therapist, the clinical populations in their work settings, their views of preferred treatment approaches in Cambodia, barriers to service delivery, and types of training needed to address the concerns of the people of Cambodia. The leading requests for the future development of mental health training included the need for training in marriage and family therapy, assessments, and play therapy. Domestic violence, depression, and anxiety/stress were also placed at the top of the mental health issues reported.
