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Alliance is a robust contributor to the outcome of adult, youth, and family therapy, but little is known about therapists’ contributions to the alliance in conjoint family treatment. We investigated the predictive value of therapists’ personality, clinical experience and observed alliance building behaviors for mid-treatment alliance as reported by therapists and family members. Participants were 77 parents and 21 youth from 57 families receiving home-based family treatment from 33 therapists. Therapist openness to experience and agreeableness as well as therapists’ in-session engagement and emotional connection behaviors predicted more positive therapists’ and family members’ reports of the alliance. Therapist neuroticism, extraversion and conscientiousness predicted more negative alliance-reports. In-session safety behaviors also predicted more negative alliance-reports, but this finding was only significant for therapists’ and not family members’ reports of the alliance. Clinical experience did not predict quality of alliances. We conclude that training and supervision of family therapists could benefit from focusing on emotional connection with and active engagement of family members in treatment, and from increasing self-awareness of the impact of their personality on alliances with family members.

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.

Premature termination is significantly understudied in couple and family therapy research yet is a prevalent issue for therapists and has a significant impact on therapeutic outcomes. While therapeutic alliance has been consistently linked to premature termination and other treatment outcomes, little is known about other factors, particularly couple factors, that may influence premature termination in couple therapy. Utilizing dyadic data combined from two different samples of couples seeking therapy, this study examines the influence of relationship satisfaction and therapeutic alliance on premature termination using an Actor Partner Independence Model. Additionally, a chi-square difference test was used to determine differences in therapeutic outcomes among termination-status type groups. Results showed that alliance was not predictive of termination status. Couple factors, particularly relationship satisfaction, were found to be associated with premature termination. That is, couples with lower relationship satisfaction were more likely to terminate therapy prematurely without agreement with their therapist. Findings suggest that couple influences showed stronger associations to premature termination than did therapeutic alliance alone. This highlights a need for therapists to assess how initial relationship satisfaction influences alliance and how each partner’s satisfaction and alliance influence that of the other partner.

This retrospective observational study aimed to examine the expanded therapeutic alliance in relation to drop out versus retention in systemic family therapy. Forty cases randomly selected from archived records at a university center for family therapy were identified as either dropouts (n = 13) or completers (n = 27). Videotapes of all first sessions were rated using the system for observing family therapy alliances by two trained judges. Identification of the alliance-related behaviors exhibited by clients and therapists in these sessions showed that compared to completed cases, dropout cases had significantly weaker clients’ alliances as well as more severely split alliances. Moreover, the three most critical dimensions of the alliance in relation to termination status were client engagement in the therapeutic process, a felt sense of safety within the therapeutic context, and the family’s shared sense of purpose about the needs, goals and value of therapy (i.e. the within system-alliance). These findings are consistent with other research that established an association between the therapeutic alliance and treatment retention in family therapy. Clinical implications for addressing the alliance threats in the first session are discussed along with specific recommendations for alliance training.

Although the AAMFT Code of Ethics encourages therapists to become competent in working with gender identity, transgender care is an area that often receives little attention in traditional therapy education and training programs. Consequently, it is essential that supervisors are competent and skilled in helping supervisees navigate, process, and increase their own competencies in working with transgender populations. A framework would help supervisors to navigate transgender competency development with supervisees. Feminist models of supervision have been shown to provide frameworks, guidance, and language for facilitating the exploration of critical issues for marginalized and diverse populations. The purpose of this paper is to demonstrate how a feminist approach to supervision can empower supervisors to help marriage and family therapy trainees develop competency in transgender care. Domains of intersectionality, power, gender, diversity, emotion, and socialization are discussed, along with a vignette that demonstrates the application of the proposed model to transgender care.

The turn of the century saw a shift from input-based to outcome-based education in Marriage and Family Therapy (MFT) training. An attempt was also made to establish core competencies that practitioners of MFT should attain to provide effective client care. These developments had a significant impact on version 11.0 and 12.0 of the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) Accreditation Standards. Since then, MFT educators have used these standards and guidelines to transition their programs from input-based to competency-based education. The MFT program at a West Coast University was the first COAMFTE accredited program to propose an alternative competency model requiring the completion of 300 direct client contact hours instead of 500 h for all students in the program, when it went through the process of reaccreditation in 2019. The program was granted renewal of accreditation in May 2020. Since then, version 12.5 of the COAMFTE Accreditation Standards have been released and this University’s competency model is aligned with these new standards. This article provides an overview of the competency model used by the MFT program at this University which can serve as an example for other MFT programs. Trends and future directions in competency-based MFT education are also discussed.

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.

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.

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.

The aim of this study is to analyze the initial therapeutic alliance in family therapy with high-conflict divorced parents and identify facilitating elements of change. We sampled 16 family therapy cases (32 parents) from a public healthcare hospital in Spain. Based on the System for Observing Family Therapy Alliances (SOFTA-o) ratings, we divided the total number of cases into two groups, depending on the presence or absence of parents’ positive indicators in the Shared Sense of Purpose dimension (i.e., productive within-family collaboration or within-system alliance). We quantitatively described and compared the initial therapeutic alliance of the two groups. To deeper explore the within-system alliance process of change, we completed the discovery-oriented phase of the Task Analysis methodology. The main differences between groups were found in the Safety dimension, which was higher in the group of cases with indicators of within-system alliance. More detailed differences were also found. The Task Analysis suggested a model of the within-system alliance process of change grounded in three main categories -or stages- that occurred sequentially (1. Narratives of conflict, 2. Narratives of joint responsibility, and 3. Narratives of opportunity) and a category that appeared in different moments across the task resolution (0. Contextualization). Five sub-categories emerged in a recursive movement within categories 1 and 2. Implications and recommendations for practice are described along with limitations and suggestions to continue this line of research.

Therapists often conceptualize resistance as client behaviors that impede progress; this perspective threatens the therapeutic alliance, especially in couple and family therapy where increased resistance and multiple alliances are present. Polyvagal theory reframes and normalizes resistant behaviors as preconscious, protective responses emerging from our autonomic nervous system. The theory also explains how humans reciprocate safety cues to connect with each other; therapists can use concepts of polyvagal theory to manage their own emotional regulation and foster safety and connection in therapy. Polyvagal concepts deepen our understanding of protective behaviors presenting in couple and family therapy; therapists can help couple and family clients to recognize protective behaviors in their own relationships and facilitate safer connection and engagement. Clinical implications are presented: psychoeducation can help clients normalize and understand their protective processes; therapist presence and immediacy acknowledges and normalizes protective behaviors as they arise; therapist and client self-regulation skills support connection; therapist genuineness is a precondition to client safety; and understanding of polyvagal theory enhances assessment of conflict and enactments in couple and family therapy.

The number of individuals experiencing Alzheimer’s disease is increasing as the population ages. The majority of individuals experiencing Alzheimer’s disease receive care from a family member, most often a spouse or adult child. Adult child caregivers have unique needs and life situations that put them at increased risk for caregiver burden and burnout. While both individual therapy and family therapy have been used with family caregivers, little scholarship has explored the role of couples therapy in improving caregiver outcomes. This article explores contributing factors to adult child caregiver burden and applies contextual therapy to treat these problems in couples therapy. We use a clinical vignette to illustrate the application of fairness, balance, loyalty conflicts, and constructive/destructive entitlement to caregiving. In all, we identify common dynamics in couples wherein one or both partners are primary caregivers for parents with Alzheimer’s disease and provide clinical suggestions on how to assess and treat these challenges in couples therapy.

The paper reports on findings from an empirical study based on qualitative interviews with Norwegian parents identified as part of a high-conflict divorce situation and interviews with caseworkers from a child welfare service. The site of study is an institutional circuit of concern, assessment, and referral involving the court, child welfare services, and a public family therapy service. The paper draws on the social ontology and analytic concepts of institutional ethnography and adopts parents’ standpoint to explore how their knowledge and experience are shaped through encounters with professionals in the process of being identified and assessed as a high-conflict divorce case. The focus on people’s doings and their expert knowledge about their doings sets institutional ethnographic research apart from more conventional forms of qualitative inquiry that focus on informants’ inner experience. The paper highlights how a generalized professional discourse seems to permeate the work that parents and caseworkers jointly engage in, sometimes subsuming the knowledge and experience of those involved. When the issues of life as subjectively known and experienced are different from those of the institutional discourse, there is a danger that what is important to those whose lives they concern escapes the dialogue between parents and professionals.

In a recent study 56% of women and 37% of men were survivors of childhood sexual abuse. These individuals who experience sexual trauma may experience depression, anxiety, post-traumatic stress disorder (PTSD) or substance use disorders (Devlin et al., in Fam J 27(4):359–365, 2019). While there are several treatment approaches specifically developed to target trauma and its effects, (e.g., trauma focused cognitive behavioral therapy, and eye movement desensitization and reprocessing) we propose that integrating internal family systems therapy (IFS) and solution focused brief therapy (SFBT) offers a brief, systemic way to improve family relationship patterns in families where one member has experienced sexual trauma. A case vignette is used to show the integration of these two approaches.

Systemic Autism-related Family Enabling (SAFE) is a new intervention for families of children with a diagnosis of Autism Spectrum Disorder (ASD). SAFE responds to international and national recommendations for improved care and the reported needs of families. SAFE draws from Family Therapy techniques, Attachment Narrative Therapy and known preferences of individuals with autism. Twenty two families of a child with a diagnosis of ASD severity level 1 or 2 were recruited. The families attended five 3-hour sessions. Family members completed the Helpful Aspects of Therapy Questionnaire (HAT) after each session. Analysis of the HAT data revealed that adults and children experienced SAFE to be helpful which was elaborated in terms of the following themes: therapist as helping reflection, increased understanding, feeling closer, more confident to reflect and problem solve, improved communication and feeling less alone and isolated. The findings are discussed to consider how SAFE can be improved and implemented to offer support for families. SAFE is a good candidate to fill a gap in autism related care.

The purpose of this study was to investigate the association between interpersonal trauma history and relationship satisfaction, and the mediating effect of differentiation—the ability to balance a separate and connected sense of self—as described in Bowen’s family systems theory. Data were collected through an online questionnaire distributed upon consent at an on-campus couple and family therapy clinic. Differentiation was measured by the Family Distance Regulation scale, comprised of items from the Separation-Individuation Test of Adolescence (SITA; Levine et al. in J Person Assess 50(1): 123−137, 1986. https://doi.org/10.1207/s15327752jpa5001_14 ), and the Social Connectedness Scale-Revised (SCS-R; Lee et al. 2001). Results suggested that interpersonal trauma history was negatively related to level of differentiation. However, when including number of children and relationship length as control variables, differentiation was not supported as a mediator between interpersonal trauma history and relationship satisfaction. When couples present with interpersonal trauma history, it may be useful for couple and family therapists to focus on differentiation levels to encourage a balance of separateness and connectedness.

Diversity and inclusion have become key phrases within Marriage and Family Therapy education programs, particularly those accredited by the Commission on Accreditation for Marriage and Family Therapy Education, as there are standards related to these concepts. However, consistent guidelines regarding how to infuse diversity and inclusion into Marriage and Family Therapy education are lacking. The current article provides an outline of one Marriage and Family Therapy education program’s preliminary efforts to ‘closing the loop’ on the instruction and evaluation of diversity and inclusion with the program. The closing the loop process involved six steps 1) explore the MFT literature and relevant organizations, 2) collect data from key practice oriented stakeholders using qualitative and quantitative measures, 3) review current procedures and brainstorm, 4) consult with key knowledge oriented stakeholders, 5) develop and implement a comprehensive and thorough assessment and evaluation plan, and 6) aggregate and evaluate data to engage in modification to the assessment plan as warranted. This paper has two goals. The first goal is that this paper will serve as an example for other programs who are struggling to infuse or demonstrate the infusion of diversity and inclusion within their programs. The second goal is to reflect on lessons learned from this program’s quality improvement process.

The Satir Growth Model (SGM) is one of the foundational models in the couple/marriage and family therapy (C/MFT) field. Satir’s model lacks the overt use of a critical lens for conceptualizing power related to the intersection of race, gender, sexual orientation, etc. Retrospective analyses of Satir’s work suggest that she did not avoid gendered issues of power in practice yet the SGM model does not offer specific instruction on how to work with these constructs in systemic therapy. This paper delineates the application of intersectional feminism onto Satir’s growth model as a critical lens for conceptualizing systems of power and oppression and the resulting impact on client lives. Intersectional feminism modernizes Satir’s Growth Model by bringing a foundational C/MFT model into alignment with the present emphasis on diversity and social justice in the systemic therapy fields. This manuscript provides a concise summary of SGM and highlights the need for infusing SGM with intersectional feminism to produce the Intersectional Growth Model (IGM). An overview of the key critically-informed tenets and assumptions of the intersectional growth model (IGM) is provided. Practices related to goals, the therapeutic relationship, assessment, diagnosis, interventions, and the change process are described.

While it is likely that Couple and Family Therapists will treat clients with interpersonal trauma history, not much is known about how interpersonal trauma history associates with the therapy process in couple and family therapy settings. The aims of this study were twofold: (1) describe the types of interpersonal trauma that couples, seeking treatment for relationship issues, have experienced, and (2) investigate how this history of interpersonal trauma was associated with the process of treatment, including therapeutic alliance, number of sessions attended, and termination status. Data were collected through a survey distributed upon consent at an on-campus couple and family therapy clinic. Participants included 73 couples who were assessed for physical abuse, sexual abuse, and experiences of abandonment using Carlson et al.’s (Psychol Assessment 23(2):463, Carlson et al., Psychological assessment 23:463, 2011) Trauma History Screen. Using content analysis, responses were categorized into three groups: both partners, only one partner, and no partners reported having experienced an interpersonal trauma. Results revealed that just under 50% of individuals had experienced some type of interpersonal trauma, affecting 71.2% of couples. Quantitative analyses were conducted to assess for significant differences, and effect sizes, among trauma categories in terms of number of sessions attended, termination status, and therapeutic alliance. Results suggested that couples who had previously experienced interpersonal trauma, particularly when both partners reported interpersonal trauma, may be more likely to terminate without agreement or no-show. Future researchers should continue to investigate how the presence of interpersonal trauma in dyads associates with the therapeutic process and clinical outcomes to better inform couples’ therapy treatment.

This article reports a study examining the impact of online spiritual counseling (OSC) sessions in mitigating immigration stress and promoting better marital adjustment of South Asian young dual earner couples emigrating to the USA. The OSC was effective for intervention group couples as compared to the waitlist control group. Post-test immigration stress was lower for those with professional degrees and who had prior living experience in the USA. Marital adjustment scores were higher for Hindu and Sikh couples, with professional degrees, who had prior living experience in the USA, for whom the marriage was a personal choice, and who had no children. Intervention compliance in terms of attendance and self-practice mediated the association between socio-demographic predictors and outcomes. There was concordance in outcomes of the dyadic partners, immigration stress and marital adjustment scores of husbands and wives were interdependent and associated. Within family therapy, the effectiveness of the OSC sessions for immigrant couples is supported with modifications for certain subgroups. Refinements may include adding familiar spiritual tenets for Christian and Muslim couples, including aspects of dealing with acculturation for those with no prior emigration experience and partner adjustment for couples in arranged marriages, and simpler expectations from those with children.

Couple and family relationships are central in processes of substance use and gambling disorders, yet they remain inadequately researched and marginally addressed in services found in the health system. Multiple barriers exist that favour a focus on the individual due to organization structure and discourse, shortage of couple therapy training, and values and philosophy of addiction services. This article describes a successful strategic initiative to foster a partnership for researchers and health system decision-makers to promote a health system change. We identify impactful factors in a two-day integrated knowledge translation workshop bringing together practitioners, researchers, decision-makers and couples seeking services for gambling and substance use disorders. The initiative shifted awareness of decision-makers, built a network of collaborative relationships and created a consensus for action among stakeholders. This early integrated knowledge translation strategy opened up research partnership on a couple therapy randomized trial in the health system, training for counselors, and research opportunities for graduate students.

Compared to typically developing people, adults with high functioning autism (HFA) are more likely to have been abused during childhood, which would inescapably affect the present relationship with their parent(s). This paper narrates the healing journey of a Hong Kong Chinese family of an adult daughter with HFA, depression and suicidality through two family-focused interventions, structural family therapy (SFT) and multiple family therapy (MFT). Identifying the history of child maltreatment sheds light on direction for treatment. Treatment principles of SFT and MFT adapted to meeting the needs of this clientele are highlighted. Issues of integrating these two approaches are discussed.

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.

The aim of this study was to use the dyad as the unit of analysis in exploring the associations between interpersonal trauma and its impact on the development of the therapeutic alliance and relationship satisfaction in early sessions of couple therapy. The sample consisted of 110 different-gender couples who were seeking treatment at an on-campus midwestern university Couple and family therapy clinic. The results showed that interpersonal trauma had an impact on the development of alliance in therapy, such that male’s own trauma was negatively associated with their bond score, while their partners’ trauma was positively associated. Likewise, for male partners, when their female partners have experienced more trauma, their relationship satisfaction decreases early on and then increases by the 5th session. However, it does not reach the same level of satisfaction as male partners whose female partners have had no experience of trauma. Couple and family therapists can strengthen the therapeutic alliance, which is essential for treatment outcome, and tailor their therapeutic approach, by considering the underlying relational mechanisms when treating couple clients who report histories of interpersonal trauma.

Research on how families deal with setting boundaries and rules for young family members is very limited in the field of family therapy. By using content analysis methods, the six authors were able to qualitatively analyze the findings from 28 evidence-based articles from multiple journals that yielded five themes that may prove useful for educators, family therapists, researchers and parents. The five themes include: Parental Efficacy; Parenting Styles; Mediation, Monitoring and Collaboration; Adolescent Risk and Risky Behavior; and Adolescent Constructive Internet Use. Parents with positive Internet experience and parents who employed a more positive attitude toward their adolescents appeared to be more efficacious in controlling their adolescents’ use of the Internet. Age and gender were important in how parents monitored the Internet usage of their daughters and sons; older adolescents were given more freedom of choice. Parents who embraced an authoritative parenting style mediated Internet use more than authoritarian or neglectful parents. Implications suggest that parents are more successful in setting boundaries when they themselves have more than basic skills, are willing to negotiate Internet use with their adolescents, and are aware of gender differences in Internet use. Therapeutic strategies for building healthy Internet use in families include: developing family values that include input from the adolescent; building parent skills and understanding of the Internet; and supporting parents in mentoring and guiding their adolescents in setting healthy boundaries that fit their maturity and gender. It is crucial that therapists help parents protect their children as they take a collaborative and positive approach to educating their children about both the risks and positive aspects of the Internet.

East Asian Americans, and Asian Americans broadly, engage in psychotherapy less than their White and minority peers. Given the mental health needs of this growing population, this comprehensive review examines the development of the therapeutic alliance with East Asian American families through the lens of cultural values that may be salient to East Asian American clients' mental health and therapeutic needs. The article explains that unique East Asian values may contribute to the development of the therapeutic alliance with East Asian American families. Given the state of the research, this article strove to elucidate what the field of Marriage and Family Therapy knows and how family therapy may be an approach that aligns with East Asian American cultural values. Finally, the article outlines a case example that explains how cultural values impacted an East Asian American family and how a culturally-aware family therapy approach may help develop a therapeutic alliance with the family.

There are a multitude of family therapy models that have shown to be effective in promoting positive client outcomes. However, there has yet to be an integrated approach to family therapy that sheds a new light on theory of change as a collective theory. In this innovative approach to family therapy theory of change, ‘change’ is defined by a family’s structure, socially constructed goals for treatment, social location, and strengths. The purpose of this paper is to integrate family therapies to construct a cohesive approach to family therapy. This integration is formed by encompassing a structural conceptualization of families while incorporating narrative attitudes of empowerment, solution-focused’s goal-orientation, a multicultural framework, and a strengths-based positivity to better serve clients.

Building a therapeutic alliance with clients is an essential therapeutic task and primary skill taught in all clinical training programs. However, there is less research available that addresses how the therapeutic alliance changes when the client is a couple or family system. This study utilized focus groups with therapists at varying experience levels to explore how they conceptualized and practiced alliances with couple and family clients. All therapists emphasized the systemic therapeutic alliance as vital to progress. Less experienced therapists conceptualized alliance as connecting to each individual separately and equally. More experienced therapists focused on building an alliance with the client system, as well as individual clients. Using modified grounded theoretical analysis, three themes emerged: (a) create the systemic alliance, (b) monitor the system’s complexity, and (c) balance individual and systemic needs. Implications and recommendations for clinicians, educators, and supervisors are presented. A model of systemic alliance in the process of couple and family therapy is introduced and discussed.

Child-oriented family therapy places great emphasis on involving children directly in the course of therapy. The research question for this study was as follows: what are foster parents’ experiences from participating in child-oriented family therapy? To answer this question, we conducted four semi-structured qualitative interviews with foster parents who were connected to a child and adolescent mental health clinic. With the use of interpretative phenomenological analysis, four main findings were identified: (1) The therapist’s competence and way of being have significance; (2) Therapy helps in getting to know the inner life of the child; (3) The everyday life of the family is worked with through the sandbox; and (4) Understanding the child’s perspectives helps foster parents to relate in new ways with the child. The study showed that child-oriented family therapy provides arenas and facilitates dialogical processes in which the child is heard. The foster parents found that child-oriented family therapy had its starting point in real challenges the family faced every day. The concrete work in child-oriented family therapy led the foster parents to experience better collaboration between family members.

Psychotherapy is generally effective for resolving a variety of presenting problems. However, the mechanisms of change that contribute to this effectiveness are not generally well-understood. The purpose of this paper is to present refinements to an instrument developed to assess client perception of therapy productiveness. In other words, what things occur in therapy sessions that clients identify as giving rise to success in achieving their therapeutic goals. This paper presents the results of a confirmatory factor analysis to test and refine the factor structure of the Productive Processes Inventory. A sample of 286 individuals in individual, couple and family therapy completed the PPI and related measures. Results showed that a modified three factor structure presented the best fit to these data. Implications for research and clinical practice are presented and discussed.

This article examines the professional identities of family therapists employed by Family Counselling Services (FCS) in Norway and their experiences providing therapeutic services to parents whose children are placed in public care. Through focus groups and individual interviews, a qualitative study of seven family therapists in FCS found that they struggle with contradictory positions when guiding parents due to the dichotomy between their personal feelings and theoretical background as systemic therapists. The struggle emerges when different systems indicate different versions of reality and when the therapists react to how the welfare system, in general, treats parents with such experiences. This study argues that a systemic approach to family therapy is useful both for dealing with parents’ often fragmented stories and for reconnecting parents to society by allowing them to tell their own stories. In these situations, the help offered by therapists is often inadequate for the complexity and enormity of the parents’ needs. Collaboration with other welfare institutions is particularly important in such cases, but this creates its own complications due to the fact that different actors interpret situations in different ways.

The founders of the field of marriage and family therapy (MFT) have often spoken of the importance of having children present during therapy. However, children provide new challenges to any therapy session and therapists are often reluctant to invite them into session (Johnson and Thomas in J Marital Family Ther 25(1):117–123, 1999; Korner and Brown in J Family Psychol 3(4):420, 1990). Our littlest clients may be the most likely to trigger self of the therapist (SOT) reactions due to their emotional and reactive nature. Research has explored how licensed therapists view children in therapy and children’s opinion about being included, (Miller and McLeod in Family J 9(4):375–383, 2001; Ruble in Contemp Family Ther 21(4):485, 1999; Sori et al. in Sori (ed) Engaging children in family therapy, Routledge, New York, 2006; Sori et al. in Family J 23(4):427–434, 2015) but less research has been devoted to how student and recent graduates respond to families and children. Further, there is almost no research addressing how a therapist’s own family of origin may impact his or her clinical judgment. This study examines how current and recent marriage and family therapy students think about including children in therapy. Seventy-three participants completed the Family Therapy Questionnaire as well as questions related to their family of origin. Participants’ responses were compared to prior studies on therapists’ attitudes and the inclusion of children. Regression analysis showed that students’ beliefs about including children in session were related to year in school as well as communication in one’s family of origin. Clinical decisions regarding family-focused vignettes were also impacted by family of origin characteristics. These results, as well as future directions for research and MFT education, will be discussed.

Despite current demands for transgender inclusive family therapy, family therapy training programs provide limited coursework on gender identity and inclusive practice. As a result, written resources are critical for family therapists wanting to provide inclusive services to transgender clients. In the interest of expanding available resources, this article uses an ecological framework to summarize research findings on the unique resiliency and difficulties experienced by transgender people. This was done in the interest of identifying implications for family therapy and distilling these implications into a collection of concrete suggestions for transgender inclusive family therapy practice. A conceptual model and a table of concrete suggestions are included at the end of the article.

Successful student recruitment is key to the flourishing of the field of marriage and family therapy (MFT). In this mixed methods study, guided by the theory of planned behavior, we interviewed 21 undergraduate juniors and seniors on their attitudes, subjective norms, and perceived behavioral control with respect to applying to MFT master’s programs within 2 years of graduation. Using their responses, we constructed and administered a survey to 174 participants. The survey included both direct and belief-based measures of attitudes, subjective norms, and perceived behavioral control towards applying. Overall, subjective norms (i.e., perceived social pressures from family, friends, professors and advisors, and MFT insiders) had the greatest predictive power of potential applicants’ intention to apply. We discuss the implications for MFT student recruitment, and offer specific recommendations.

The Satir model greatly impacts the thinking and practice of therapists in the field of family therapy. This two-phase study aimed to validate a self-report instrument, the Perceived Self-Transformation Scale, which measures the self-transformation proposed by the Satir model. A panel of expert reviewers evaluated the content validity of the items developed by the authors. Exploratory and confirmatory analyses with 500 Chinese subjects yielded a 17-item scale with four factors, namely, self-connectedness, self-doubt, others-oriented, and openness to share. Concurrent validity of the scale was supported in the second phase of the study where 96 Chinese subjects participated. Results indicated that the scale is a reliable and valid outcome measure for the Satir model. The study can contribute to transforming Virginia Satir’s work into an evidence-based practice.

The purpose of this qualitative study was to understand therapists’ strategies, benefits, and challenges in working with therapy dogs in couple and family therapy. Eight individuals participated in semi-structured interviews; areas of inquiry included how therapists made the decision to work with a therapy dog, how the therapy dog was managed in session, the impact of the therapy dog’s presence in the therapy process, and concluded with recommendations for therapists who aspire to work with canine-assisted psychotherapy (CAP) in their practices. The data were analyzed using transcendental phenomenology. The findings suggest that the majority of therapists who use CAP with couples and families find it to be beneficial for their clients, the therapy dog, and the therapists themselves, with the identification of a few challenges. Participants reported that compared to individual therapy, in which the therapy dog is included to fulfill a treatment goal or enhance a therapy model, in couple and family therapy, the therapist was much more flexible in regards to the therapy dog’s presence. Overall, therapists observed the system’s dynamics as family members interacted with the dog. Additionally, the majority of participants reported on the therapy dog’s ability to help the therapist better understand their clients and the dog’s presence also helped to overcome challenges particular to working with more than one client. Clinical and research implications are discussed.

In the marriage and family therapy (MFT) field, minimal attention has been given to in-session therapy processes that influence clients’ decisions to persist in therapy or prematurely discontinue therapy. To prevent premature discontinuation, therapists need a better understanding of why clients leave treatment before completing it. In this grounded theory study, we interviewed 19 clients of MFTs to examine how they made decisions about therapy persistence or discontinuation. Factors that impacted participants’ decision to discontinue therapy were: client motivation, the therapeutic alliance, therapy productiveness, including the therapist’s understanding of the problem, the therapist’s frame of the problem, therapy pacing, and neutrality in relational therapy. Results support the importance of common factors in facilitating therapeutic change.

Chronic health conditions affect over 100 million Americans (Cano and Leonard in J Clin Psychol 62(11):1409–1418, 2006). Many clinicians are not integrating chronic physical health symptoms into psychotherapy. There is a complexity of issues that arise within the context of chronic health conditions. Making more need for couple and family therapists, whose primary focus is on a systemic family perspective, to understand how chronic health conditions are impacting family systems when they present for therapy (Canavarro and Dattilio in Contemp Fam Ther 33:87–90, 2011; Poleshuck et al. in Prof Psychol 41(4):312–318, 2010). The correlation of chronic health conditions on marriages and relationships has received limited attention in clinical research. This secondary data analysis examines the differences in overall well-being and psychological distress of individuals and couples seeking therapy who report a presence of chronic health conditions. Original research on the relationship between chronic health conditions and well-being, as measured by comparison of means, will be presented. Few studies investigate how chronic health conditions, when not the primary reason for seeking therapy, influence wellbeing and distress upon entering therapy. This study included 2742 participants from a clinical sample of individuals and couple seeking therapy in a family therapy clinic at a university training clinic. Independent t-tests, as well as ANOVA, were run to compare well-being and psychological distress of individuals and couples in the sample. Results showed significant differences in both overall wellbeing and psychological distress for both individuals who reported chronic illness for themselves, or their partners, than those that reported no chronic illness. There were also significant differences between groups on both well-being and psychological distress [F (2, 2706) = 47.55, p = .00, F (2, 2697) = 54.59, p = .00]. This results showed significant differences in well-being when no member of the couple has chronic health conditions, one member, or both members, with both members decreasing wellbeing significantly. This study demonstrates that chronic health conditions impact both the individual diagnosed, their partners, and is especially impactful if both members of a couple are diagnosed with chronic health conditions. Study limitations and clinical implications are also discussed.

Contextual therapy focusses on restoring and enhancing relationships, based on its paradigm of relational ethics, presuming a human tendency for reciprocal care. It is precisely in a time of stressed relationships that this focus on strengthening humanity is of great importance. This article presents the first study on the application of this paradigm into concrete interventions of 12 current contextual therapists, answering the question: How do contextual therapists apply the contextual theory and therapy into concrete interventions? Using the Thematic Analysis, 14 therapy sessions were analyzed, revealing a typical working-method and eight characteristic categories of interventions. The findings of this qualitative research reveal a consistent working-method and several recognizable contextual elements. These may contribute to further integrating the paradigm of relational ethics in family therapy and developing a contemporary contextual guideline for therapy. It also provides a conditional step for investigating the efficacy of contextual therapy, for evidence-based research, and for further development of the methodology of contextual therapy.

Reentry research has received much less attention than research on cultural adjustment in a foreign country, especially in the marriage and family therapy (MFT) field in the United States. Lack of research on international students’ job experiences and professional developments during reentry does not provide further information to evaluate the quality of MFT education in the United States. This study was intended to extend the reentry literature and specifically to understand personal and professional reentry experiences and cross-cultural transformation of MFT returnees in Taiwan. Thirteen participants were interviewed, and the resulting data was analyzed using constructivist grounded theory. Analyses results demonstrated macro contextual factors that situated unique personal and professional reentry phenomena for international MFT graduate in Taiwan. The returnees strived to explore their MFT identity and interpret cross-cultural differences by developing four coping strategies (e.g., not wanting to fit in, doing what you were supposed to do or could do, processing with others, and therapists’ multicultural awareness) that were associated with three conditions, such as personal networks linking to professional networks, supervision, and training in MFT. Findings suggested that reentry adaption was varied and fitting into Taiwanese society might not be the final goal for the returnees. Training implications in the MFT field were provided based on the findings.

This study tested whether there was a significant salary difference between women and men working as faculty in Marriage and Family Therapy (MFT) programs within public universities. Additionally, we evaluated whether there were significant differences in academic attributes and how these academic attributes related to gender differences in salary. Results from our Oaxaca decomposition of salary differentials showed academic attributes like the number of peer-reviewed publications and years in academia could be used to explain the $9000 gap found between women and men in our sample of MFT academics. Our results indicated no evidence of salary discrimination against women working as MFT faculty members but showed that women were shown to have significantly less time in academia and to publish significantly fewer peer-reviewed journal articles than men. Implications of the current study findings include developing effective mechanisms for helping women persist in and advance through pathways of MFT academic promotion as well as for helping increase their scholarly productivity.

Rural communities experience considerable disparities in mental health. Research about this topic is limited, however, especially in the family therapy field. What is known comes primarily from work in other disciplines, which points to three primary barriers that prevent rural communities from accessing high quality mental health care: availability, accessibility, and acceptability of services. A search for papers published over the past 20 years in family journals yielded only 18 articles. A review of these articles in presented here, alongside a call for family clinicians and researchers to advance further contributions. Specific directions for such research are discussed, including telehealth technology, collaboration with existing structures and institutions in rural communities, and the need for more precise definitions and measures of rurality. Family clinicians and researchers are uniquely positioned to conceptualize systemic challenges that rural communities face, and would be advised to join other disciplines in developing innovative methods to address them.

Family therapists are increasingly called upon to work with individuals and families with medical issues, but often do not have sufficient background on the issue to be most helpful. The purpose of this paper is to help family therapists understand Parkinson’s Disease (PD) and its impact on the individual and his or her family. PD is the second most prevalent neurodegenerative disorder in the United States, following Alzheimer’s disease (Hirtz et al., Neurology 68:326–337, 2007). According to the Parkinson’s Disease Foundation, approximately 60,000 individuals are diagnosed with PD every year, and approximately one million Americans are currently living with PD. In this paper, we provide an overview of PD based on research and the second author’s many years of providing services for individuals with PD, as well as offer specific recommendations for providing family therapy using narrative, solution-focused and emotionally focused therapy based on the first author’s work as a family therapist with individuals, groups, and couples dealing with PD.

The purpose of this study was to explore Marriage and Family Therapy students’ experiences attending Overeaters Anonymous (OA). Utilizing a qualitative survey administered in an addictions course at an institution located in a rural area of the United States, 18 marriage and family therapy (MFT) graduate students reflected on their participation in both online and telephone meetings. In this study, MFT students provided their perspectives regarding the feasible utilization of Overeaters Anonymous in clinical treatment, with an emphasis on the consideration of social support for clients who may reside in rural areas. Three major themes emerged which included (1) enlightenment through exposure; (2) OA as a viable adjunct to therapy; and (3) convenience and comfort. The study addressed recommendations for MFT education, clinical implications, and future research.

This research explores the effects of counseling based on mindfulness and acceptance on the marital conflict of intercultural married women in Iran. The population of this study was all intercultural married women in Isfahan city, Iran. After interviewing for finding suitable participants, a total number of 30 participants were recruited and assigned to two matched groups of control and experiment. Participants in both groups were asked to complete a demographic questionnaire and revised marital conflict questionnaire. Experimental group then completed the 8 weekly, 90 min counseling based on Gehart’ treatment plan (Mindfulness and acceptance in couple and family therapy, Springer, New York, 2012), the control group did not receive any intervention. After the completion of the counseling, participants in both groups were asked to complete the questionnaires as post-test. Results indicate that this program affected marital conflict in participants and significantly decrease it. Due to numerous Challenge in the life of intercultural couples, designing and implementing effective intervention plans seems necessary and constructive.

Although rarely used by family therapists, musical interventions have the potential to become a more common technique in family therapy. Music’s unique therapeutic properties engage families, including young children and adolescents, in a meaningful, therapeutic, “here-and-now” creative process. Musical interventions act as catalysts, enable direct communication, and augment authentic communication patterns in a playful atmosphere. The purpose of this explanatory mixed-methods research was to obtain a greater understanding of the clinical applicability, therapeutic value and future implementation of a musical intervention carried out by family therapists in a family therapy context. The study explored the outcomes of 35 participating family therapists who attended a designated workshop on a structured family-based musical intervention, 18 of whom then applied 38 family-based musical sessions focused on family roles in their clinical work. The results illustrate the family-based musical intervention is a noteworthy tool for family clinical assessment and treatment, easily applicable in a variety of private and public settings with diverse populations. Musical instruments used as intermediary objects are potent vehicles for growing family awareness, functioning, and congruence, as well as inducing opportunities for change. The family-based musical intervention manifests the potential of an interdisciplinary, holistic, biopsychosocial approach to promoting individual and family wellbeing. The article also addresses ethical considerations and implications for family therapy training and education programs.

A critical and often overlooked issue is the lack of measurement tools that are congruent with the systemic and developmental guiding principles of the Marital and Family Therapy field. In this current study, we test the dyadic supervision evaluation (DSE) focusing on the internal consistency, specifically the developmental trajectory of trainee and supervisor factors during a year in supervision. This study demonstrates how these factors stabilize over time. The DSE psychometrics are evaluated with a sample of 205 dyads that are tested longitudinally over four time points. We employ repeated measures ANOVA with intra-class correlation (ICC) to measure the level of consistency of the subscales over time. The results of this analysis show that the factors for trainees have an ICC average range of 0.66–0.80, and the factors for supervisors have an ICC average range of 0.69–0.84.

Nowadays, information and communication technologies (ICTs) represent an integral part of contemporary family life, introducing changes in families’ functioning. Positive, negative, and mixed aspects of this influence were identified. The present study intends to understand the relationship between ICTs and family functioning among participants from two different family life cycle stages. A total of 157 Portuguese families (307 participants from 97 families with emerging adult children and 169 from 60 families with adolescents) completed measures about the use of ICTs (an adaptation of SEFT/ETEF©) and family functioning (SCORE-15). The number of ICTs and problems related to their use were higher in families with adolescent children. The use of a higher number of ICTs was related to a better level of family functioning in both family groups. However, according to the multiple regression model, the problematic situations related to ICTs use only seem to predict a worse level of family functioning in families with adolescent children. Also, parents and children of each group differed in the number of ICTs used. Some limitations, implications for family therapy, and future research directions are discussed.

In contemporary society, digital media are fully integrated in our daily lives, indispensable for our routines, always connected and at-hand. Our research thus explores the parental mediation of portable digital devices in families with young children, addressing the following questions: (a) which are the most common parental mediation styles adopted towards young children; and (b) which individual features of the parents or contextual factors influence the parental mediation style adopted. Our methodology is exploratory and qualitative, considering as empirical corpus 14 national reports from the European-scale study “Young Children (0–8) and Digital Technologies” for a comparative thematic analysis. The authoritative style was the most common parental mediation style related to technology use. In general, there are transversal rules to all parental mediation styles (except laissez-faire style), such as withdraw or give devices to children according to their behavior, control (inappropriate) content and control the time of use. Also, parental perceptions and attitudes about the technologies played a heavier weight on the parental mediation style adopted, and consequently influenced the relationship of the children with digital media. Some implications for future studies, preventive actions, and family therapy are discussed.