The transition to teletherapy in marriage and family therapy training settings during COVID-19: What do the data tell us?

In the wake of the COVID-19 pandemic, little is known about how university training programs transitioned to teletherapy. This study describes the transition of two university marriage and family therapy (i.e., master's and doctoral) training clinics to teletherapy and presents preliminary analyses of the types of clients and cases that converted to teletherapy. A series of chi-square analyses, a t-test, a logistic regression model, and a multiple linear regression model were employed. Four key findings emerged: (1) most cases converted to teletherapy; (2) Hispanic ethnicity was the only demographic characteristic to significantly predict conversion to teletherapy; (3) individual cases were significantly more likely to convert to teletherapy than relational cases; and (4) the number of prior in-person sessions attended significantly predicted conversion to teletherapy. Teletherapy conversion implications are discussed across four systemic levels: client, student trainee, supervision, and larger systems.

A call to action: Online learning and distance education in the training of couple and family therapists.

Distance education in couple and family therapy (CFT) has grown in recent years; however, due to the COVID-19 pandemic, many CFT educators find themselves delivering emergency online education out of necessity and for the first time. Despite the growth of distance learning over the last decade, there is virtually no CFT scholarship on the topic. Comparable disciplines, including social work and professional counseling, are further along in researching distance learning. Outside of the counseling disciplines, there is also ample scholarship guiding the delivery of distance education. This article builds on the small body of CFT scholarship on technology in training and supervision, reviewing extant research on distance learning in social work and counselor education. Major themes in this research reveal opportunities and challenges associated with distance learning and offer guidance about ways that CFT education can evolve in order to effectively integrate technology and online learning into our educational landscape.

Integration of teaming therapy and mixed-reality simulation as remote learning modality for couple and family therapy graduate training programs.

In response to COVID-19, a couple and family therapy (CFT) graduate training program integrated a teaming therapy model with virtual technology using mixed-reality simulation software. By utilizing teaming therapy--a model with strong roots in systemic theory and practice-- combined with cutting-edge simulation technology, this distance learning modality provides distinctly relational therapy supervision and training for students at a time when their internships sites are struggling to offer remote clinical services due to the pandemic. This integrative framework offers a high degree of both realism and safety, allowing experiential learning to be appropriately scaffolded for optimum creativity and engagement in an online setting. This paper describes the conceptual, systemic basis for the learning modality, steps for implementation, benefits of the model, and the authors plan for further evaluation.

Way of being and the therapeutic pyramid: Expanding the application of a common factors meta-model.

Common factors proponents have suggested the need for principle-based meta-models to explain how various factors interact with each other to produce change. The therapeutic pyramid is a common factors meta-model that outlines how therapeutic skills and techniques, the therapeutic alliance, and a therapist's way of being interactive to produce therapeutic change. Skills and techniques occupy the smallest top portion of the pyramid, with the therapeutic alliance in the middle and a therapist's way of being forming the foundation of the pyramid. The success of any layer rests on the quality of the immediately underlying layer. This study illustrates the broad applicability of common factors meta-models by applying the therapeutic pyramid to couples therapy, family therapy, training and supervision, and professional ethics.

Behind the (Virtual) Mirror: Online Live Supervision in Couple and Family Therapy.

Online therapy and supervision, a rapidly rising practice in couple and family therapy, has been the subject of a growing body of literature. From its early days, family therapy training has included live supervision, which has typically been conducted by a supervisor and a team of trainees situated on the other side of a one-way mirror. With the outbreak of the COVID-19 global pandemic, we-the staff of supervisors at the Barcai Institute in Tel Aviv, Israel-were compelled to find solutions to continue meeting with clients and to provide supervision for family therapy trainees. To this end, we have shifted our live supervision courses ("practicums") to the virtual arena, adapting the popular application "Zoom" into what we call "PractiZoom." Based on over 100 PractiZoom sessions conducted between March and May 2020, involving 14 supervisors and 28 therapists-in-training and their clients, the article reflects on this pioneering online practicum for the online live supervision of therapists with geographically distributed participants. In this article, we outline our operational methods and adaptations for conducting live behind-the-mirror supervision online. Following a short theoretical background, we outline the process of online live supervision, discuss our reflections and those of our trainees on the challenges and possibilities it poses, and offer a number of preliminary conclusions and recommendations.

La terapia y la supervisión en línea, una práctica que está aumentando rápidamente en la terapia de pareja y familiar, ha sido tema de publicaciones crecientes. Desde sus primeros días, la capacitación en terapia familiar ha incluido la supervisión en vivo, que normalmente ha sido dirigida por un supervisor y un equipo de practicantes ubicados del otro lado de un vidrio de visión unilateral. En la medida de nuestro conocimiento, la bibliografía aún tiene que abordar la supervisión en línea en vivo que incluya una familia, un terapeuta, un supervisor y un equipo, todos en línea. Con el brote de la pandemia mundial de la COVID-19, nosotros─el personal de supervisores de Barcai Institute de Tel Aviv, Israel─nos vimos obligados a encontrar soluciones para continuar las reuniones con los pacientes y supervisar a los practicantes de terapia familiar. Con ese fin, hemos trasladado nuestros cursos de supervisión en vivo ("prácticas") al área virtual, adaptando la famosa aplicación "Zoom" a lo que nosotros llamamos "PractiZoom." Sobre la base de 100 sesiones en PractiZoom realizadas entre marzo y mayo de 2020, en las que participaron 14 supervisores y 28 terapeutas en prácticas y sus pacientes, el artículo reflexiona sobre esta práctica innovadora en línea para la supervisión en línea de terapeutas con participantes geográficamente dispersos. En este artículo, describimos nuestros métodos operativos y adaptaciones para llevar a cabo una supervisión en línea en vivo detrás del espejo. Después de un breve marco teórico, describimos el proceso de la supervisión en línea en vivo, debatimos nuestras reflexiones y las de nuestros practicantes sobre las dificultades y las posibilidades que plantea, y ofrecemos numerosas conclusiones y recomendaciones preliminares.

Short-Term and Long-Term Effects of Training in EFT: A Multinational Study in Spanish-speaking Countries.

This study seeks to validate the cross-cultural effectiveness of emotionally focused couple therapy (EFT) training in a sample of Spanish-speaking clinicians. The 28-hr formalized training for EFT was offered in six different Spanish-speaking countries, covering Europe, North America, Central America, and South America. Two hundred and seven therapists of 14 different Spanish-speaking nationalities completed pre-training assessments, 153 of them completed post-training assessments, and 92 therapists also completed the follow-up assessment. Using multilevel growth modeling (MLM), results indicated that therapists experienced significant and positive changes in terms of EFT competence (knowledge and skill acquisition), mature empathy, self-compassion, and attachment over time. Implications for transnational EFT training, specifically in Spanish-speaking countries, are discussed.

The Digital Divide: Couple and Family Therapy Programs' Integration of Teletherapy Training and Education.

The mental health field is increasingly integrating and growing a teletherapy presence, and couple and family therapists are uniquely situated to offer these services based on our history of innovative approaches to therapeutic services. To do so successfully, careful consideration of training and education must occur. To evaluate current teletherapy training and education opportunities of COAMFTE accredited couple, marriage, and family therapy programs, an inductive qualitative content analysis was conducted on the responses of 95 faculty at COAMFTE accredited programs. Findings indicate that more than two thirds of the participants were in favor of teletherapy integration in training programs; however, most programs currently do not offer such opportunities. Barriers that prevent such integration were highlighted as well as existing concerns to training graduate students in teletherapy. Implications for training programs, policies, and regulations are discussed.

The Experience of Learning EFT in Spanish-speaking Countries: A Multi-National Replication Study.

This study is a multi-national follow-up to the original (Sandberg and Knestel (2011) Journal of Marital and Family Therapy, 37, 393-410) article on the process of learning Emotionally Focused Couples Therapy (EFT). A total of 102 clinicians from nine Spanish-speaking countries (Mexico, Costa Rica, Guatemala, Spain, Colombia, Argentina, Chile, Ecuador, and El Salvador) participated in the study. A comparison of results across the two studies revealed more similarities than differences. However, a few notable differences emerged from responses to qualitative questions, namely a heightened sense of appreciation for and resonance with the focus on core emotion in EFT and less frequent reports of difficulty learning and adapting to the model among Spanish-speaking therapists. These differences were consistent with common cultural values and forms of expression in Latin America and Spain. Results are discussed in terms of training, supervision, and future research as well.

Integrative Systemic Therapy: Lessons on Collaboration and Training for the 21st Century.

The field of couple, marital, and family therapy (CMFT) is at an important juncture of identity development and synthesis. Integrative Systemic Therapy (IST) is a problem-centered metaframeworks approach that meets the growing needs of family therapists working with diverse and complex family systems and restores the field to its original focus on collaboration. This paper describes the process by which IST developed featuring anecdotes from live interviews with the founders. We briefly outline IST's theoretical pillars and the essential way IST practitioners deliver treatment including a blueprint for therapy. Finally, we propose that IST is a comprehensive, systemic guide uniquely beneficial to CMFT training and discuss our approach to integrating IST into our training of students in a COAMFTE accredited program.

A Tool for Connection: Using the Person-of-the-Therapist Training (POTT) Model in Emotionally Focused Couple Therapy Supervision.

Emotionally Focused Couple Therapy (EFT) was developed based on the premise that couples get stuck in negative cycles fueled by their underlying primary emotions and unmet attachment needs (Johnson [2004], Creating connection: The practice of Emotionally Focused Couple Therapy). EFT therapists need to stay in touch with and regulate their own emotions when the tension rises in the sessions, while still staying open and vulnerable to their clients. Person-of-the-Therapist Training model (Aponte & Kissil [2016], The person of the therapist training model: Mastering the use of self) aims to increase therapists' understanding, awareness, and acceptance of their own personal issues to create a more empathic connection with their clients. In this manuscript, the authors create a roadmap for EFT supervisors to use the POTT model in supervision as a tool to enhance their supervisees' connection to their clients and effectiveness of their interventions.

Couple-based Intervention for Depression: An Effectiveness Study in the National Health Service in England.

This study represents an effectiveness study and service evaluation of a cognitive behavioral, couple-based treatment for depression (BCT-D) provided in London services that are part of the "Improving Access to Psychological Therapies" (IAPT) program in England. Twenty-three therapists in community clinics were trained in BCT-D during a 5-day workshop, followed by monthly group supervision for 1 year. The BCT-D treatment outcome findings are based on 63 couples in which at least one partner was depressed and elected to receive BCT-D. Eighty-five percent of couples also demonstrated relationship distress, and 49% of the nonclient partners also met caseness for depression or anxiety. Findings demonstrated a recovery rate of 57% with BCT-D, compared to 41% for all IAPT treatments for depression in London. Nonclient partners who met caseness demonstrated a 48% recovery rate with BCT-D, although they were not the focus of treatment. BCT-D was equally effective for clients regardless of the clinical status of the nonclient partner, suggesting its effectiveness in assisting both members of the couple simultaneously. Likewise, treatment was equally effective whether or not both partners reported relationship distress. The findings are promising regarding the successful application of BCT-D in routine clinical settings.

Couple relationship education program "Living as Partners": evaluation of effects on marital quality and conflict

Abstract Relationship education programs are strategies that can favor better marital quality and conflict management between spouses. The relationship education program "Living as Partners: Turning Challenges into Opportunities" seeks to promote the couples' learning of conflict resolution strategies and better quality levels in the relationship. This study evaluates the capacity of this program to produce results regarding marital quality and three dimensions of the couple's conflict: frequency, intensity, and resolution strategies. Data from 41 couples were analyzed before and after the program, and a follow-up after 5 months (n = 33 couples) were conducted as well (single group, pre-test, post-test, and follow-up quasi-experimental design). Results show that the program produced immediate effects in all the outcome variables, which remained significant after 5 months, except for marital quality and for the strategy of compliance. These outcomes showed effect sizes ranging from low to high levels. The study presents evidence about the ability of the "Living as Partners" program to produce improvements in couple's conflict indicators, addressing an unexplored field of research and intervention focused on Brazilian cultural specificities.

Training for Connection: Students' Perceptions of the Effects of the Person-of-the-Therapist Training on Their Therapeutic Relationships.

The Person-of-the-Therapist Training (POTT) is a program designed to facilitate clinicians' ability to consciously and purposefully use their selves to effectively connect, assess, and intervene with clients. This study explored CFT students' perceptions of the effects of POTT on their ability to create positive therapeutic relationships. Course papers and final reflections were collected from 70 CFT students. Directed content analysis looking for evidence-supported elements of positive therapeutic relationships revealed 5 elements: empathy, management of countertransference, balancing multiple alliances, positive regard, and bond. Findings support the idea that a structured program focused on the training of the personal aspects of the therapists, like POTT, can promote the evidence-supported elements that make a therapeutic relationship effective.

The State of Lesbian, Gay, and Bisexual Affirmative Training: A Survey of Faculty from Accredited Couple and Family Therapy Programs.

This study explored the state of lesbian, gay, and bisexual (LGB) affirmative training in the couple and family therapy field. LGB affirmative refers to holding positive views of LGB identities and relationships. A total of 117 faculty members completed the online survey for this study. Participants were asked to respond to items on the following topics: LGB affirmative stances, LGB affirmative program environment, LGB affirmative course content, self-of-the-therapist work, and professional opportunities to work with LGB topics and clients. The findings of this study were encouraging as participants reported holding positive beliefs about LGB individuals, that their training programs had fairly affirmative program environments, and that LGB affirmative course content was included in their program curriculum.

Teaching office-based couples counseling skills: enhancing residents professional and personal relationship skills.

Effective communication skills are essential for: 1) developing therapeutic physician-patient relationships; 2) negotiating within healthcare teams; and 3) maintaining meaningful personal relationships. This article describes a behavioral science seminar designed to teach residents the fundamentals of couple dynamics and familiarize them with a variety of tools for enhancing communication skills. The seminar consists of a didactic portion, a review of learning materials and instructional DVD, and group discussion. Learning objectives include: a) recognizing the developmental stages of relationships; b) identifying potential communication barriers; and c) use of communication skills tools in three contexts including patient care, healthcare teams, and personal relationships. The seminar is conducted for third-year residents on an annual basis; concepts and materials are reinforced throughout all 3 years of training.

Common factors of change in couple therapy.

Though it is clear from meta-analytic research that couple therapy works well, it is less clear how couple therapy works. Efforts to attribute change to the unique ingredients of a particular model have consistently turned up short, leading many researchers to suggest that change is due to common factors that run through different treatment approaches and settings. The purpose of this article is to provide an empirically based case for several common factors in couple therapy, and discuss clinical, training, and research implications for a common factors couple therapy paradigm. Critical distinctions between model-driven and common factors paradigms are also discussed, and a moderate common factors approach is proposed as a more useful alternative to an extreme common factors approach.

The experience of learning Emotionally Focused Couples Therapy.

This study examined the process of learning Emotionally Focused Couples Therapy (EFT) as reported by 122 EFT therapists and therapists-in-training. Participants completed an online questionnaire assessing their experiences of learning EFT, with particular emphasis on EFT theory, alliance, interventions, perceived impact on clients, and impact on self. Findings suggest that therapists are drawn to the attachment-based model of EFT, appreciate the EFT framework and structure, that clients endorse the usefulness of the model and that learning the model has contributed to personal healing and improved relationships for the trainees. Results also show that the transition to EFT from another model can be taxing and requires time, support, and additional supervision/training to increase comfort level and competency with EFT. Nevertheless, results also highlight that learning EFT can be a rewarding and worthwhile endeavor.

Supervising emotionally focused therapists: a systematic research-based model.

Emotionally Focused Therapy (EFT) is an empirically validated relational therapy that recognizes the complexity of couple's therapy and supports the need for specialized training of therapists. Until now, there has been little research on effective methods for EFT supervision and no systematic model for conducting EFT supervision. The findings of a qualitative study of certified EFT therapists' experiences with EFT supervision and training are presented in this study, along with a systematic model of EFT supervision. The model of EFT supervision is based on the findings of this study, relevant research regarding effective clinical supervision, and the authors' experiences with EFT supervision. This model of EFT supervision is isomorphic to the clinical practice of EFT, in that it is theoretically grounded in attachment theory and emphasizes experiential and emotionally based processes.