Families are central to psychiatric rehabilitation, providing emotional, practical, and advocacy support that enables recovery for individuals with serious mental illness. Despite growing endorsement of family-centered care, the literature remains dispersed across diagnoses, service models, and disciplines, and there is limited synthesis of how families are engaged across psychiatric rehabilitation over time. This scoping review synthesizes 83 studies published between 2005-2025 on family roles in rehabilitation. Evidence shows that when families are actively involved, through psychoeducation, therapy, and peer-led programs, outcomes improve such as symptom reduction, relapse prevention, and functional gains. Caregivers often demonstrate resilience but face significant stress, stigma, and systemic barriers. Cultural norms and policy frameworks strongly influence family engagement; while some regions integrate families into care, others lag. Not all patients desire family involvement, highlighting the need for flexible, person-centered approaches. Key implications include expanding family-inclusive programs, training providers, and addressing confidentiality and resource gaps. A shift toward family-centered psychiatric rehabilitation is evident; however, systematic implementation remains uneven.
AI has touched every element of professional space and transformed how we work. The ripple effect of using AI to manage workflow, solve problems, and engineer efficiency extends to other elements of professional life and practice. There is significant literature surrounding the ethical use of artificial intelligence generally and a great deal with therapeutic practice, but limited information on how specifically the ethical considerations apply to systemic therapists. CMFTs must not only learn how to use AI but also how to critically assess its limitations and preserve therapeutic integrity. The purpose of this paper is to present core ethical principles that couple and family therapists need to understand to integrate AI into their clinical practice. The principles described highlight not just the ethical principles for the CMFT professional but also consider how clients' uses of AI intersect within the therapeutic work we do. Direct connections to the AAMFT Ethical Code (2026) are outlined and future directions presented.
Systemic therapy has long emphasized relational context, power, and the ethical implications of therapeutic stance. This conceptual article reexamines systemic commitments to neutrality and reflexivity in light of contemporary wellness discourses that operate as regulatory systems within broader sociocultural contexts. Drawing on second-order cybernetics and systemic, community, and ethical scholarship, the paper conceptualizes individualized wellness discourse as a recursive regulatory system shaped by cultural norms, institutional incentives, and market forces that influence therapeutic neutrality and case formulation. The analysis engages longstanding debates within family therapy regarding neutrality, power, and social responsibility. The article distinguishes resilience, often framed as individual adaptation, from resistance, understood as relational and collective processes that challenge structural conditions contributing to distress. The paper further translates these concepts into clinical practice through case illustration, therapist dialogue, and multilevel systemic interventions grounded in Integrative Systemic Therapy (IST) and the Web of Human Experience. This paper highlights the importance of integrating structural analysis into clinical reasoning while maintaining appropriate professional boundaries. By clarifying the concept of systemic responsibility, this article contributes to ongoing conversations within family therapy regarding the relationship between therapeutic stance, social context, and professional ethics.
Kleptomania is a rare and under-researched impulse control disorder characterized by recurrent, irresistible urges to steal items of little or no personal value. Despite its significant impact on relational functioning, there are no existing case reports documenting the use of couples therapy for kleptomania or other impulse control disorders. This case report presents the couples therapy undertaken with a 57-year-old woman diagnosed with kleptomania, hoarding disorder, and dysthymia, who was seen with her husband for 37 sessions of integrative couples psychotherapy. Therapy followed an assimilative integration approach grounded in Emotionally Focused Couples Therapy, incorporating theoretical principles and techniques of Cognitive Behavioural Couples Therapy. Therapy enabled emotional disclosure, reconceptualization of distress, and improved relational functioning. This case illustrates the utility of a systemic lens in treating individual psychopathology and underscores the need for relational interventions in managing impulse control disorders, where family factors play a significant role in both the development and maintenance of the illness. Written informed consent for publication was obtained from the couple.
Artificial Intelligence (AI) encompassing machine learning (ML), deep learning, and generative AI (GenAI), is increasingly shaping clinical and therapeutic landscapes. This paper conducts a review of current literature on the use of AI in various therapeutic contexts. It examines how AI technologies such as chatbots, predictive models, and AI-enabled robotics are being applied across diverse populations to support prescreening, diagnosis processes, symptom tracking, behavioral monitoring, and clinical systemic interventions. These tools have demonstrated potential in improving therapeutic outcomes, including reducing symptoms of depression and anxiety and enhancing cognitive and behavioral functioning. The review highlights specific benefits and explores the broader implications of these applications within clinical practice. However, concerns such as algorithmic bias, data privacy risks, and the lack of emotional nuance in AI responses pose significant risks to therapeutic integrity and relational attunement. Moreover, the absence of formal training and clearly defined ethical guidelines for clinicians raises questions about responsible implementation. Systemic therapists, in particular, must remain vigilant about how AI may reinforce dominant cultural narratives or marginalize underrepresented voices. Therefore, as AI continues to evolve, ongoing professional engagement and ethical scrutiny are essential to ensure its responsible and equitable integration into clinical care. Given the rapidly changing nature of these technologies, therapists are recommended to remain informed and approach their use with flexibility and caution.
The rapid advancement of artificial intelligence (AI) is transforming the landscape of behavioral health, inviting systemic therapists to reconsider their professional identities, competencies, and ethical responsibilities. This paper presents a reflective dialogue between Dr. Afarin Rajaei and Dr. Katherine Hertlein, exploring how AI intersects with relational practice, professional training, and clinical ethics. Drawing upon Hertlein's emerging conceptual framework for AI competence in systemic therapy, the authors discuss the knowledge, ethical awareness, and relational sensibilities necessary for responsible integration of AI in clinical and educational contexts. Their exchange illuminates both the opportunities and cautions of AI adoption, emphasizing that systemic therapists must remain reflexive human agents guiding technology toward compassionate and equitable care.
The present mixed-methods study examines outcomes among premium users of the AI-assisted psychotherapy platform Psyhelp. From a pool of approximately 40,000 users, 10% (approximate to 4,000) were premium subscribers (i.e. full access to journaling, interventions, self-monitoring). Using stratified random sampling via G*Power calculations, n = 200 premium users were selected for quantitative analysis of symptom change (depression, anxiety, emotion regulation, self-esteem, attachment/dependency) and engagement metrics (journals, minutes of use, intervention modules). Qualitative in-depth data (n = 20) explored user experiences, perceived mechanisms of change, and contextual factors influencing engagement. Results show statistically significant pre-to-post reductions in symptom severity (paired t tests, large effect sizes) with higher engagement associated with greater improvement. Qualitative themes include "awareness to action," "digital habit formation," and "relationship to the algorithm." Discussion focuses on implications for digital therapy scalability, human-AI collaboration in mental health, and directions for future research. Limitations include sample representativeness, self-report bias, and lack of long-term follow-up. This study contributes to the growing evidence base for AI-augmented psychotherapy in real-world settings.
Artificial intelligence (AI) is increasingly integrated into couple and family therapy (CFT) education, offering innovative approaches to skill development and experiential learning. The following conceptual paper examines the application of video-based AI tools in CFT graduate programs, addressing both opportunities and ethical considerations. While AI technologies present potential benefits such as enhanced access to simulated therapeutic scenarios, personalized feedback, and supplemental learning experiences, significant concerns remain regarding confidentiality, privacy, cultural bias, and the limitations of AI in capturing the relational complexity central to systemic practice. The authors present a reflective framework, EEE (Empower Students, Enhance Curriculum and Engage Students in Learning) and assessment tool to guide educators in evaluating the professionalism, clinical appropriateness, and pedagogical suitability of AI-generated therapeutic scenarios. This framework emphasizes AI as a supplemental resource rather than a replacement for human supervision, clinical training, or therapeutic relationships. Recommendations for ethical implementation in CFT curricula are discussed.
This paper offers recommendations for Systemic Family Therapy (SFT) educators on the ethical and pedagogically sound integration of generative artificial intelligence (GenAI) into clinical training. We outline GenAI's potential to support learning, assessment, and clinical reasoning, while also addressing significant ethical, relational, and equity concerns. Although GenAI use is rapidly expanding in higher education, structured frameworks for its implementation in SFT training remain limited, which risks inconsistent training and disparities across programs. Drawing on our experiences as four SFT educators who have piloted GenAI in our curricula, we examine practical applications and emerging challenges. We emphasize the need for transparent academic integrity policies, explicit guidance for responsible use, and opportunities for experiential and reflective learning. We call on SFT programs and accrediting bodies to develop clear competencies, policies, and critical engagement strategies that position GenAI as a supportive resource rather than a replacement for human relational processes. With intentional integration, GenAI can enhance clinical preparation while preserving the centrality of therapeutic presence and systemic relational ethics.
Artificial intelligence (AI) has pronounced utility in systemic therapy when used with clear purpose, ethical alignment, transparency, specialized models, and guardrails for safety. This paper offers a practical roadmap for couple and family therapists (CFTs) to integrate AI in treatment as a support to, rather than a replacement for, human clinical judgment and processes. Strategies for using AI in systemic therapy include: 1) identify and articulate the function and purpose clearly, 2) distinguish AI's role in treatment as the agent or tool, 3) align with professional standards and ethical codes, 4) promote transparency in AI use and processes, 5) prioritize the use of smaller, domain-specific language models when feasible, 6) establish robust safeguards and risk-mitigation protocols, and 7) formalize critical thinking processes. The strategies are presented in detail and accompanied by applied examples and ethical guidelines intended to support clinicians, supervisors, training programs, and clinical systems. A description of how to implement the strategies is presented, including a template of an AI-informed consent for clinical care. Implications for training and supervision are discussed.
Infidelity can cause negative impacts in interpersonal relationships, especially for nonparticipating partners. These effects may mirror symptoms of post-traumatic stress disorder, leading clinicians to assess for and treat these symptoms in therapy. However, current measures for post-traumatic stress symptoms used after infidelity discovery may not capture the full breadth of nonparticipating partners' responses. The purpose of this study is to evaluate the appropriateness of the Impact of Events Scale- Revised (IES-R) as a measure to capture the subjective level of distress experienced after infidelity discovery in intimate relationships. This study utilizes a deductive qualitative analysis to examine the experiences of nonparticipating partners that occur at infidelity discovery, as well as test the IES-R as an assessment measure to ensure it adequately captures the experiences of and responses to infidelity discovery. Supported and refined themes are discussed to provide clinicians with a more complete understanding of infidelity discovery responses to ensure appropriate assessment and treatment in therapy. Additionally, expanded themes within infidelity discovery responses highlight the need for not only trauma responses to be addressed, but grief to be considered as well.
The study explored family bonding in scheduled tribe families, emphasizing its cultural significance and impact on familial well-being. A phenomenological research design was adopted, incorporating Braun and Clarke's thematic analysis framework. Data was collected through a focus group discussion involving 14 scheduled tribe parents, providing insights into their lived experiences and perspectives on family bonding. The findings highlighted key themes that included adherence to traditional values, equality in marriage, parental behavior, resilience, acceptance, and responsibility. The study further identified the role of internal dialogue, emotional reliance, grit, and mindfulness in strengthening family bonds. Despite a limited sample, findings showed the importance of open communication and cultural preservation in inculcating strong familial relationships. These findings provide a foundation for further research and family therapy interventions to strengthen scheduled tribe family bonds through culturally sensitive approaches.
This study examined the effectiveness of group training based on the PREPARE/ENRICH program in enhancing marital adjustment, expectations, and goal orientation among couples without significant conflict. An experimental design with a pretest-posttest control group and a three-month follow-up was used. From 107 volunteers, 34 eligible couples were randomly assigned to experimental and control groups; 30 completed the study. The experimental group attended seven sessions of relationship enrichment training, while the control group received no intervention. The Spanier Dyadic Adjustment Scale, Omidvar Marital Expectations Questionnaire, and Eggeman Marital Goal Orientation Questionnaire were used for assessment. Repeated measures analysis showed that the training significantly improved all three outcomes in the experimental group, and the effects were maintained at follow-up. The findings underscore the value of structured relationship enrichment programs like PREPARE/ENRICH in promoting healthy marital dynamics, fostering long-term relational stability, and helping to prevent the emergence of marital conflicts.
Internalizing and externalizing behavioral issues among children tend to appear together and are often interrelated. A combination of Solution-focused brief therapy (SFBT) and Mindfulness is theoretically promising in reducing the co-occurrences of internalizing and externalizing issues. In this study, we developed and validated MBSFT-C, which addresses internalizing and externalizing behavioral issues. Preliminary components of MBSFT-C were developed, integrating the philosophies of Mindfulness and Solution Focused Brief Therapy. We used a two-round Delphi survey to finalize and validate these components. In the first round, the experts provided a free-text review of the initial components of MBSFT-C, which were then analyzed thematically using QDA Miner v2.0.9 software. In the second round, the experts evaluated the final components of MBSFT-C and reached a consensus using a 10-point visual analog scale. Thematic analysis of review 1 revealed three themes, Validation, Additions, and Modifications, based on which the final draft of MBSFT-C was developed. The final draft included two major components, Mindful Solution Focused Engagement and Family Mindfulness Skills. All the components of MBSFT-C achieved international expert consensus with a 70% agreement in review 2. The mean score for components by the experts ranged between 7.50 and 8.00 out of 10 on a visual analog scale, with a standard deviation ranging from 1.94 to 2.95. MBSFT-C will provide clinicians with a well suited, empirically developed, manualized comprehensive therapy that meets the special requirements of children.
Our goal in this paper is to highlight the significance of Stage 1 stabilization processes in Emotionally Focused Individual Therapy (EFIT). Stabilization is a prerequisite to the modification of working models of self and other that typifies Stage 2 of EFIT, and we propose that it also has significant stand-alone value as a change event. We begin by defining the process of stabilization and delineating how it is a foundational part of the overall Emotionally Focused Therapy (EFT) model of change. Then we illustrate the autonomous value of the stabilization change event and show how stabilization is related to outcome in theory and in practice. Third, we demonstrate the use of specific interventions, the macro-moves and micro-skills of EFT, for achieving stabilization in an extended therapist-client dialogue of client change through the four steps of stabilization. Finally, we discuss the potential for therapists to overlook stabilization and the disadvantages of doing so.
This article examines the application of Brief Strategic Therapy in treating a patient with panic disorder in a private therapy setting. The patient, a 50-year-old man with a history of panic attacks, experienced debilitating daily crises for three months despite undergoing pharmacological treatment. His symptoms were triggered by physical exercise and manifested as episodes of tachycardia, sweating, shortness of breath, and a fear of losing control. This case study describes the implementation of the Strategic Brief Therapy protocol, detailing the therapeutic maneuvers used in each phase, and provides evidence of significant reductions in panic symptomatology, avoidance behaviors, and dependency on external help. Additionally, quantitative assessments indicate a marked decrease in the intensity and frequency of attacks, alongside improvements in overall well-being. Preliminary findings suggest that the patient's quality of life improved notably from the first session, with the complete cessation of panic attacks achieved within 11 sessions. These results highlight the effectiveness and efficiency of Strategic Brief Therapy as an intervention for panic disorder.
At the intersection of artificial intelligence and systemic therapy lies a new possibility: triadic chat-based mediation, where a Large Language Model (LLM) participates as conversational facilitator between relational partners. This paper develops a conceptual framework outlining potential benefits and risks. Advantages may include continuous availability, enhanced memory for relational dynamics, reduced barriers to engagement, and support for balanced participation. Concerns arise regarding dependency, reduced self-regulation, hallucinations, bias, and risks of re-traumatization from persistent recall. The framework situates the LLM not as therapist but as tentative relational scaffold-a structure that might support dialogue but could equally risk interfering with natural conflict resolution if misapplied. By integrating perspectives from AI ethics, digital health regulation, and psychotherapy practice, the paper defines a research agenda for evaluating safety, clinical utility, and cultural fairness, advancing critical dialogue on AI's emerging role in systemic therapy.
This paper explores the therapeutic potential of the television series Ted Lasso ;(Apple TV, 2020-2023) through the lenses of narrative therapy and cinematherapy. Drawing on narrative inquiry and systemic analysis, it examines how televised storytelling can inform clinical reflection, relational insight, and emotional transformation. A synopsis of the series introduces readers to its central themes of optimism, leadership, and vulnerability, setting the stage for the narrative analysis that follows. The study identifies three interrelated themes that reflect therapeutic principles: redefining masculinity through emotional openness, promoting leadership rooted in empathy and emotional intelligence, and emphasizing relationships as catalysts for personal growth. A detailed narrative analysis, supported by specific episode and scene references, illustrates how Ted Lasso models systemic change through relational dialogue and vulnerability. By integrating current literature on narrative and film-based interventions, the paper demonstrates how popular media can be used intentionally in therapeutic and educational contexts to promote emotional literacy, reduce stigma, and enhance reflective practice. The discussion and clinical implications sections provide guidance for therapists, clients, and educators seeking to apply media-based interventions within systemic and culturally responsive frameworks.
The emergence of accessible generative artificial intelligence (AI) tools has been a transformative force across numerous disciplines, with the potential to radically alter the delivery of mental health services. To support systemic therapists in understanding and evaluating the ethical issues associated with incorporating AI into systemic therapy, we propose a framework that outlines five stages of deepening integration, from automation of processes to fully autonomous, client-facing systems. We examine each stage of integration by overlaying the AAMFT code of ethics and established ethical principles, demonstrating that ethical complexity, including both risks and benefits, intensifies as AI services become more embedded in mental health care. We also identify inflection points at which systemic therapists need to carefully consider the implications of adopting AI technologies. We conclude with a discussion of issues unique to systemic therapy, highlighting both opportunities and the imperative for educators to prepare emerging systemic therapists for an AI-driven future.
