Videoconferencing psychotherapy for couples and families: A systematic review.

The delivery of videoconferencing psychotherapy (VCP) has been found to be an efficacious, acceptable and feasible treatment modality for individual therapy. However, less is known about the use of VCP for couple and family therapy (CFT). The focus of this systematic review was to examine the efficacy, feasibility and acceptability of using VCP as a treatment delivery modality for CFT. A systematic search was conducted, data relating to efficacy, feasibility and acceptability were extracted from included studies. The search returned 7,112 abstracts, with 37 papers (0.005%) included. The methods of the review were pre-registered (PROSPERO; CRD42018106137). VCP for CFT was demonstrated to be feasible and acceptable. A meta-analysis was not conducted; however, results from the included studies indicate that VCP is an efficacious delivery method for CFT. Recommendations for future research and implications regarding clinical practice are made, which may be of interest to practitioners given the COVID-19 pandemic.

"What Next?": Toward telebehavioral health sustainability in couple and family therapy.

As a response to the COVID-19 global crisis, many in the couple/marital and family therapy (CMFT) professional community quickly met the challenge of providing services to clients via telebehavioral health (TBH) services. As this public health emergency endures, family therapists must continue to engage in TBH practice professionally and ethically. The rapid adoption of TBH with minimal training and experience during this public health emergency can result in crises for both individual therapists as well as for the profession in implementing electronic record-keeping, conducting virtual sessions, and communicating online with various clinical populations. The risk of insufficient training and supervision create a challenge to new and experienced family therapists. This article summarizes the work done by the profession thus far to respond to this public health emergency and presents a roadmap of recommendations for navigating those challenges into the future and offers ideas about how to sustain quality TBH practice.

Couple teletherapy in the era of COVID-19: Experiences and recommendations.

The unprecedented times of the novel Coronavirus quarantine and subsequent stay-at-home orders have changed the way many couple therapists provide clinical services. Understanding couple therapists' experiences with teletherapy is important for optimizing future telehealth delivery with couples. Thus, the purpose of this mixed methods survey study was to explore couple therapists' experiences of transitioning from in-person/traditional therapy to online/telehealth delivery. A total of 58 couple therapists completed an online survey for this study. Reported are both quantitative and qualitative findings. Overall, this study found that couple therapists experienced a positive shift from traditional/in-person therapy to online/telehealth therapy, with a majority of couple therapists (74%) reporting they would continue providing teletherapy after the novel Coronavirus pandemic and social distancing regulations had ended. Thematic analysis was used to identify themes from couple therapists' experiences related to advantages, challenges, and recommendations for practice. Implications for clinical training and future research are discussed.

Moral distress of medical family therapists and their physician colleagues during the transition to COVID-19.

The COVID-19 pandemic has transformed healthcare for both clinicians and patients. This conceptual article uses ideas from the moral distress literature to understand the challenges MedFTs and physicians face during the COVID-19 pandemic. The authors highlight earlier themes from the moral distress literature and share current reflections to illustrate similar challenges. Some clinicians who were already experiencing a rise in burnout due to the mass digitization of healthcare are now facing increased moral distress due to ethical dilemmas, pervasive uncertainty, boundary ambiguity, isolation, and burnout brought about by emerging COVID-19 policies. Fears about personal safety, exposing loved ones, financial concerns, self-doubt, and frustrations with telehealth have contributed to increased moral distress during the COVID-19 pandemic. Building resilience by setting one's personal moral compass can help clinicians avoid the pitfalls of moral distress. Five steps for developing resilience and implications for guiding trainees in developing resilience are discussed.

Systemic teletherapists' meaningful experiences during the first months of the coronavirus pandemic.

Fifty-five clinicians who provided teletherapy to couples, partnerships, families, and kin networks during the first two months of the coronavirus pandemic responded to a survey about their most and least meaningful experiences. Reflexive thematic analysis indicated that the participants experienced adjustments to their schedule or routines, they used technology glitches to promote client growth, and they altered how they engaged clients. Participants noted shifts in their personal and relational dynamics. They reported feeling fatigued and resilient. Participants described their adaptability, gratitude, digital and relational connectivity, and an ability to reframe negative experiences into opportunities for growth.

Toward proficiency in telebehavioral health: applying interprofessional competencies in couple and family therapy.

During the coronavirus pandemic, many behavioral health professionals providing psychotherapeutic services, including couple/marriage and family therapists (C/MFTs), quickly changed from providing in-person services to telebehavioral health (TBH) services, with specific reliance on teleconferencing. Many therapists were thrust into telehealth with minimal or no prior telebehavioral health experience, education, or training. Although TBH services have been shown to be effective and efficient with mental health and substance abuse problems, the teaching and learning of telebehavioral competencies have generally not been included in the formal education and training received by C/MFTs. This article presents an existing interprofessional telebehavioral health competencies framework not before published in C/MFT journals. This article will also demonstrate how those competencies are applicable to the education, training, and practice of telebehavioral health by C/MFTs. Implications for educational, service, and regulatory organizations are presented.

Clinical Supervision of Couple and Family Therapy during COVID-19.

This paper addresses the need for a swift transition from in-person clinical supervision to telesupervision during the time of the COVID-19 global pandemic. Five specific areas will be discussed in the effort to enhance the quality of clinical supervision provided to couple and family therapists in training at this time including the following: (1) COVID-19 and the structural changes and technological adaptation of supervision; (2) culturally and contextually sensitive guidelines for clinical supervision during COVID-19; (3) the supervisee's competence and the clinical supervisory process; (4) the new set of boundaries and the supervisory role; (5) and the supervisory alliance and supervisees' vulnerabilities in the face of COVID-19.

En este artículo se aborda la necesidad de una transición rápida de la supervisión clínica en persona a la telesupervisión durante el periodo de la pandemia mundial de la COVID-19. Se tratarán cinco áreas específicas con el fin de mejorar la calidad de la supervisión clínica ofrecida a los terapeutas de pareja y familiares en prácticas durante este periodo, por ejemplo: (1) La COVID-19 y los cambios estructurales y la adaptación tecnológica de la supervisión; (2) pautas que tienen en cuenta las particularidades culturales y contextuales para la supervisión clínica durante la COVID-19; (3) la competencia del supervisado y el proceso de supervisión clínica; (4) el nuevo conjunto de límites y el rol del supervisor; (5) y las vulnerabilidades de la alianza de supervisión y de los supervisados ante la COVID-19.

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.

Couples Exploring Nonmonogamy: Guidelines for Therapists.

A population that is potentially challenging for couple and family therapists to work with is that of couples who want to explore nonmonogamy. For many therapists, nonmonogamy challenges personal values and beliefs, and there is little in the literature to support therapists in achieving cultural competency in this area. Based on a review of Western clinical literature over the past 20 years and on the author's clinical experience, the author provides therapists with guidelines to use with couples who want to explore the possibility of becoming nonmonogamous. The guidelines include (a) educating oneself about nonmonogamy; (b) identifying one's own values and beliefs related to nonmonogamy;

The practical challenges of recruitment and retention when providing psychotherapy to advanced breast cancer patients.

GOALS OF WORK: The goal of the present study was to investigate recruitment issues relevant to psychotherapy trials for metastatic cancer patients. First, we undertook a literature review of the psychotherapy intervention research for metastatic cancer patients. Second, we piloted pragmatic recruitment methods for a couples' intervention for women with metastatic breast cancer and their partners. METHODS: An extensive literature search was conducted to identify psychotherapy trials involving people with metastatic cancer published in peer-reviewed journals. Study characteristics and recruitment methodologies were examined. In the pilot study, we trialled the recruitment strategies of approaching participants at outpatients' appointments, via letter, referral from the treating team and through direct advertising using two community support services. RESULTS: The literature search identified 1,905 potentially relevant articles, which were narrowed to 18 studies specifically involving metastatic cancer patients involving a professionally trained facilitator and a specified theoretical orientation. Limited information was found on recruitment rates and the success of recruitment strategies. Barriers to recruitment identified in the literature included degree of patient illness, lack of interest/perceived benefit, insufficient time, socio-demographic factors and negative clinician attitudes. Our pilot study identified 72 eligible couples of which 66 were approached. Our recruitment strategies resulted in six couples consenting (9.1%) but only three couples completing the study (4.5%). The main reasons for study refusal were the intervention was not needed, lack of interest, insufficient time, patient illness and travel distance. CONCLUSIONS: Recruitment for couple-based psychotherapy interventions is challenging. More work is required on developing acceptable and feasible recruitment processes for metastatic cancer patients to be able to access support.

A competency-based approach to couple and family therapy supervision.

The competency-based movement continues to guide professional psychology. This has been highlighted through the establishment of essential foundational and functional competencies. The current paper focuses on the intervention competency domain and delineates its relevance within the field of couple and family therapy (CFT). We begin by providing an overview of 8 essential components of CFT: developing a systemic formulation, forging a systemic therapeutic alliance, understanding family-of-origin issues, reframing, managing negative interactions, building cohesion/intimacy/communication, restructuring/parenting, and understanding and applying evidence-based CFT models. We then provide a brief illustration of foundational and functional competencies essential to CFT. We conclude by addressing the CFT competency within an integrative approach to supervision and provide a case illustration that depicts this process. The relevance of establishing unique, evidence-based, theory-specific competency components is highlighted.

Couples treatment for interpersonal violence: a review of outcome research literature and current clinical practices.

Conjoint couples treatment for interpersonal partner violence (IPV) remains controversial despite a growing body of research and practice experience indicating that it can be effective and safe. In addition, developing typologies of couples who are violent suggest that a "one-size-fits-all" treatment approach to IPV is not appropriate and conjoint treatment may have a place in the treatment of at least some couples. In this article, we review the experimental studies and clinical practices of conjoint treatment. Based on this review, we suggest current best practices for this approach to treatment. Best practices include couples treatment as part of a larger community response to IPV, careful screening of couples for inclusion in couples treatment, modification of typical conjoint approaches to promote safety and ongoing assessment of safety with contingency plans for increased risk.

Intimate partner violence risk assessment and management.

While risk assessment is important in the management of intimate partner violence perpetrators, the science and practice of risk assessment in this field are still in early development. This article reviews the literature on intimate partner violence risk assessment. The original intent was to direct discussion to assist the Military Family Advocacy Program (FAP), U.S. Department of Defense, to develop guidelines for the treatment of domestic violence offenders. The article is divided into sections as follows: (a) Defining Risk; (b) The Risk Factors; (c) Models of Risk Assessment; (d) Existing Risk Instruments; (e) The Role of the Victim in Risk Assessment; (f) Qualifications to Conduct Assessments; (g) Communicating Risk; and (h) Managing Risk. Relevant issues and controversies are raised throughout the article.

Adapted Couple Therapy (ACT) for pathological gamblers: a promising avenue.

The study of the effectiveness of treatment for pathological gambling constitutes a field that is still largely unexplored. To date, the models assessed primarily target the individual and include little or no involvement of the family circle. Yet, the deleterious effects of gambling on loved ones and especially spouses are well recognized. Further, the addition of a couple modality to individual treatment has been shown to be effective on many levels in the treatment of substances use disorders. This article therefore proposes a critical review of (1) the literature providing a better understanding of the complex interactions between the couple relationship and pathological gambling, (2) studies on the effects of couple therapies on gamblers and their partners. We then present the therapeutic model developed by our team of clinician-researchers in collaboration with actors from Québec clinical settings: Adapted Couple Therapy (ACT) for pathological gamblers. In the Québec context, this model will serve as a complement to an individual cognitive-behavioral treatment model that has been proven effective and is employed throughout the Canadian province. The assessment of couple therapies could reveal avenues of solutions to better assist pathological gamblers who tend to drop-out of treatment and relapse.

Exploring a fourth dimension: spirituality as a resource for the couple therapist.

This article explores ways in which the therapist's own spirituality can serve as a resource in couple therapy. Spirituality is defined as subjective engagement with a fourth, transcendent dimension of human experience. This engagement enhances human life and evokes corresponding behavior. Spiritually based therapy may be influenced by three assumptions: that God or a Divine Being exists, that human-kind yearns innately for connection with this Being, and that this Being is interested in humans and acts upon and within their relationships to promote beneficial change. In therapy these assumptions affect how the therapist listens and responds throughout sessions. The authors incorporate a case example illustrating the application of this fourth dimension in couple therapy.