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As research suggests that there is a strong link between the quality of the therapeutic alliance and the effectiveness of psychotherapy, family therapists should reflect on ways to improve the quality of the alliance. The systematic use of client feedback can be a rich resource as a response to the complexity of the alliance in the family therapy setting. In this paper the focus is on ways in which the client's systematic feedback can contribute to an optimisation of the therapeutic alliance. We present the Dialogical Feedback Tool (DFT), a simple feedback instrument to be used especially in family therapy sessions in which young children are involved. A case study illustrates how the feedback of clients on their experiences in therapy can help therapists to better attune to family members' experiences and expectations about therapy. Practitioner points: The therapeutic alliance in family therapy is complex, especially when children are involvedUsing a simple feedback instrument can help deal with the complexity of the therapeutic allianceThe most important challenge for therapists using feedback instruments is how to integrate the feedback in a constructive way in the therapeutic process [ABSTRACT FROM AUTHOR]

In psychosocial migration literature, the perspective of ambiguous loss has been relevant to articulate personal and relational experiences in the context of transnational families and ongoing separation. Most studies have focused on adult members' experiences of transnational families, but research exploring ambiguous loss in adolescents whose parents have migrated is still lacking. The present study aimed to explore adolescents' lived experiences of parental migration. In a pilot explorative study, 14 adolescents with at least one parent who migrated were interviewed about their lived experiences of transnational parent‐child relationships and ongoing parent‐child separation. Data analysis identified four themes in participants' accounts: practices of separation creating confusion; current relationship with migrant parents permeated by ambiguity; distrustful representations of migrant parents; and family and social dynamics reactivating the pain of loss. The findings reveal how in the context of parental migration, patterns of separation and ongoing relational processes, compounded by the uncertainty of reunification and an exclusionary social fabric, constitute core elements that shape adolescents' lived experiences of parent‐child relationships characterized by ambiguity. [ABSTRACT FROM AUTHOR]

The aim of this focus group study was to explore the experiences of family therapists working with family secrecy. Our study highlights that family secrets present important and compelling challenges for family therapists. Furthermore, our study reveals that there seem to be some basic strategies family therapists use in dealing with these challenges in therapy sessions. One basic strategy is that family therapists try to guard their position of being a trustworthy therapist for each family member by avoiding becoming stuck in family secrecy. Furthermore, therapists explore ways to guide the family toward the disclosure of the secret in order to alleviate the toxicity of the secrecy. This highlights the importance of the systemic model and how influential this perspective is in family therapy practice. Some participants, however, have in addition a second strategy they sometimes use: talking with the family about secrecy without aiming to disclose the secret. In the discussion section of the article we reflect on the possibility that in the strategic choices family therapists make conceptual issues might be involved. Furthermore, we stress the importance of further research. [ABSTRACT FROM AUTHOR]

Background: Advance Care Planning (ACP) communication is difficult to implement in hospital. Possibly this has to do with the fact that the concept is not well tuned to the needs of hospital professionals or that they experience implementation barriers in practice. Aims: The aim of this study was to investigate what is valued in having ACP conversations by hospital professionals (physicians, nurses, psychologists and social workers) and what they experience as barriers and facilitating factors for having ACP conversations with patients. Methods: A Delphi study consisting of two rounds with respectively 21 and 19 multidisciplinary experts from seven European countries was organised. Data were analysed using content analysis and descriptive statistics. Results: Participants agreed that ACP is valued mostly because it is seen to improve transmural continuation of care, emotional processing of the loss of a patient, and serenity at the end of life. Reported barriers are patient characteristics blocking patient-centred communication and a lack of knowledge to have these conversations. An important facilitator is multidisciplinary cooperation. Conclusions: There is consensus by experts from different settings and countries suggesting that these results can theoretically be applied to hospital settings in Europe. This study reveals that hospital professionals value ACP in hospital practice, but that they encounter several barriers to its implementation. [ABSTRACT FROM AUTHOR]

Background:: Hospitalists seem to struggle with advance care planning implementation. One strategy to help them is to understand which barriers and helpful factors they may encounter.Aims:: This review aims to give an overview on what hospitalists experience as barriers and helpful factors for having advance care planning conversations.Method:: A systematic synthesis of the qualitative literature was conducted.Data Sources:: A bibliographic search of English peer-reviewed publications in PubMed, Embase, CINAHL, Central, PsycINFO, and Web of Science was undertaken.Results:: Hospitalists report lacking communication skills which lead to difficulties with exploring values and wishes of patients, dealing with emotions of patients and families and approaching the conversation about letting a patient die. Other barriers are related to different interpretations of the concept advance care planning, cultural factors, like being lost in translation, and medicolegal factors, like fearing prosecution. Furthermore, hospitalists report that decision-making is often based on irrational convictions, and it is highly personal. Physician and patient characteristics, like moral convictions, experience, and personality play a role in the decision-making process. Hospitalists report that experience and learning from more experienced colleagues is helpful. Furthermore, efficient multidisciplinary co-operation is helping.Conclusion:: This systematic review shows that barriers are often related to communication issues and the convictions of the involved hospitalist. However, they seem to be preventable by creating a culture where experienced professionals can be consulted, where convictions can be questioned, and where co-operation within and between organizations is encouraged. This knowledge can serve as a basis for implementation. [ABSTRACT FROM AUTHOR]

Although transnational migration and its impact on families and society has received considerable attention from scholars, still little is known about its effects on the family members who stay in their home country. The aim of this qualitative study was to explore adolescents’ experiences of close relationships in the context of transnational migration. The study was based on in-depth interviews with male and female adolescents whose parents had migrated. For administration of these interviews, a tool consisting of 15 pieces of wood was developed in order to invite participants to represent family members in an expressive modality that could facilitate discussion and decrease tension provoked by parental migration. Thematic analysis showed that adolescents experienced growing up within tri-generational families whose structure and dynamics allow for a sense of stability. In these families, adolescents experience meaningful relationships that are important sources of support to cope with the delicate emotional situation inherent in transnational families. However, the present study also revealed that adolescents experience the relationship with their migrant parents as a recurrent source of distress and emotional ambivalence, leading to a potential perspective on the parent-child separation in the context of transnational migration as an experience of an ambiguous loss. [ABSTRACT FROM AUTHOR]

In this article, we explore how narrative accounts of trauma are co-constructed through the interaction between researcher and participant. Using a narrative multiple-case study with Kurdish refugee families, we address how this process takes place, investigating how researcher and participants were engaged in relational, moral, collective, and sociopolitical dimensions of remembering, and how this led to the emergence of particular ethical questions. Case examples indicate that acknowledging the multilayered co-construction of remembering in the research relationship profoundly complicates existing deontological guidelines that predominantly emphasize the researcher’s responsibility in sensitively dealing with participants’ alleged autobiographical trauma narratives. Instead, our analysis invites qualitative researchers to engage in a continued, context-specific ethical reflection on the potential risks and benefits that are invoked in studies with survivors of collective violence. [ABSTRACT FROM AUTHOR]

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In Belgium, Advance Care Planning (ACP) is not well implemented in hospital practice. One of the premises for successful implementation is involving the adopters in the implementation process. In hospital, important adopters of ACP are physicians, nurses, social workers, and psychologists. First, this study wants to understand what the characteristics are of ACP in hospital, according to professionals. Second, this study aims to give an insight in the experienced value of ACP. Third, the experienced barriers to have ACP conversations are explored. Twenty-four interviews were taken and analyzed with Content Analysis based on Grounded Theory. Three independent external auditors surveilled the analysis. ACP in hospital exists by the grace of the initiative of the actors involved in the case. Professionals perceive fields of tension between one another; barriers to ACP communication. ACP is mainly considered valuable because it is a process that creates time for exploration and reflection. [ABSTRACT FROM AUTHOR]

In this study a method of retrospective case supervision is presented aimed at helping the supervisee to become a better self-supervisor. The method pays special attention to the therapist's self-reflection and has the therapist's inner conversation as a central concept. The starting point of the method is an assignment in which the supervisee reflects on a case using a tape-assisted recall procedure. The method helps trainees to develop experiential expertise to become more flexible and effective therapists. A case example of one training group of novice family therapists illustrates the use of the method. [ABSTRACT FROM AUTHOR]

A personal journey and a scientific challenge, this is an autoethnographic study about my own family's secrecy. I knew my grandfather had been a German prisoner of war during World War II. We all knew. But nobody talked about it. Then one day I decided I wanted to do systematic research on the issue of family secrecy around my grandfather's war experiences. Researching one's own family can be called autoethnography. It could be said that autoethnography is an approach to research that aims to describe and systemically analyze (graphy) personal experience (auto) to understand social and cultural phenomena (ethno). This scientific approach is quite new in the field of family therapy. This study has been an important personal quest, but it also led to important reflections on silences in families, on my own professional development, and on methodological issues concerning autoethnographical research. For one thing, it highlights some of the positive aspects of family secrecy and silences, and invites us-when confronted with family secrecy in clinical practice-to carefully consider the potential destructive and life-giving aspects of the silence. [ABSTRACT FROM AUTHOR]