Search

Couple therapy research identifies partner empathy as a core process for positive outcomes. The Exeter Model of couple therapy (EMCT) for depression builds on both behavioural and empathic approaches in couple therapy to reduce unhelpful couple interactions and promote mutual understanding between partners where one partner is experiencing depression. Based on EMCT, this process research study aimed to investigate mutual understanding (MU), a transtheoretical concept that refers to the moment-by-moment therapy triad talk that constructs partner empathy. Thirty-four therapy sessions from seven couples in EMCT were screened for MU events, based on pre-defined theoretically derived criteria. A discourse analysis (DA) discursive psychology approach was utilised to examine identified MU events. Specifically, participant positioning and the constructive function of discourses were examined in the therapy extracts, as these DA concepts were closely linked to MU criteria. Findings provided insights into the couple and therapist interaction sequences that contribute to MU, suggesting that both systemic-behavioural and systemic-empathic EMCT techniques can facilitate the process. Specifically, circularities, active listening tasks, and eliciting vulnerability were identified as effective techniques for MU. Findings also pointed to clients' contributions and the impact of discordant discourses. Implications for EMCT practice, and directions for future couple therapy research are discussed.

Genograms are a widely used tool, well grounded in systemic theory. However the claims made in the literature regarding the therapeutic use and effects of the genogram have not been empirically explored or verified. This study therefore aimed to examine the extent to which the use and effects of genograms in clinical practice reflect the claims made in the literature. This study asked: what therapeutic tasks the genogram is used for, the specific pathways the genogram facilitates those tasks, and the mechanisms salient to the genogram that adds to clinical practice. Ten qualified Family Therapists participated in semi-structured interviews discussing their experiences. A Thematic Analysis was conducted. Five themes were identified: therapist-family joining; systemic exploration; therapist hypothesizing; family perturbation through cognitive change; family perturbation through experiential and behaviour change. This study found that genograms were used in some of the ways described in the literature: engagement, information gathering, hypothesizing and intervention aimed at cognitive change. The usefulness of the genogram was found to extend beyond ‘engagement’ and ‘information gathering’ to ‘therapist-family joining’ and ‘systemic exploration’ respectively. However, this study did not find the genogram was used to explore emotions, nor as an intervention aimed directly at behaviour change; instead, change at the experiential level was reported. The pathways the genogram facilitates therapeutic tasks are delineated, as are the mechanisms salient to the genogram that adds to clinical practice. Recommendations for further research were made. This included repeating this study with therapists from different training backgrounds, as well as undertaking a quantitative study examining genogram outcomes in terms of a measurable change in presenting problems.

Family Interventions (FI) are recommended in the treatment of psychosis. This is based on the robust finding that a high rating of Expressed Emotion (EE) is predictive of poor outcome. Research has looked to attachment and attribution theories to further develop our understanding of EE. This study sought to understand how the experience of FI helped family members to develop their thinking about their attachment experiences and the appraisals made about a relative, and how these discussions helped to inform their understanding about the interactional way in which difficulties could be maintained. Six master themes were identified: ‘the significance of the therapeutic relationship’, ‘understanding relationships with significant others’, ‘developing a sense of agency’, ‘making sense of psychosis/difficulties’, ‘exploring and understanding unhelpful patterns of interaction in the family’, and the ‘mechanisms of therapy that were helpful’. The FI was experienced as helpful in bringing about changes in the way family members construed each other and psychosis. This influenced patterns of relating which allowed for an emotional climate within the family that promoted a sense of agency and was experienced as healing.

Objective. Family Therapy (FT) and Family Management (FM) approaches to psychosis have been divided by their understanding of causality. FM holds a biological understanding which has been identified as having negative consequences for the person with psychosis. FT, by exploring family interactions has been criticised for blaming families for causing their relations psychosis. These two approaches have now been integrated, but how causality is discussed in an integrated approach has only now been explored. Design and methods. This qualitative research asked clinicians working in the most established integrated service how they discuss causality. Four focus groups were conducted and a framework approach using thematic analysis was used. Results. Five themes were explored; uncomfortable discussion; constructing a shared understanding; therapeutic style; limiting exploration; and blame. Conclusion. Discussing causality with families was identified as uncomfortable. However, through the development of a therapeutic-relationship three identified tools can be used to construct a shared understanding of causality. The therapeutic style of explorative conversation--based in FT, integrated with the stress-vulnerability model--based in FM, was identified as an important aspect of an integrated model that resolved criticisms levied at each individual approach. Factors that limited exploration were identified as major challenges to causality discussions, but techniques to remedy these problems were also identified. The risk of families feeling blamed/blaming themselves and attempts to avoid/reduce blame made up a dominant theme of the research. The research concludes by challenging the need to avoid/reduce blame, arguing that blame should be openly explored within family interventions.