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.

Covenant Attachment: A Constructivist Grounded Theory of Christian Couples and God.

The purpose of this constructivist grounded theory study was to develop a deeper understanding of the relational system of married couples and God. We interviewed nine marital couples from Christian denominations that reported having a strong relationship with each other and with God together. We used constructivist grounded theory techniques presented by Charmaz (2006) and analyzed emergent categories of behaviors, emotions, and cognitions to construct a theory and model of Christian marital couples and their shared relationship with God. We then compared and contrasted the results and theory to existing literature on attachment theory and theorized a shared attachment to God. We applied the theological concept of kinship covenant to the results in order to organize and situate the theory into a Christian framework. Finally, we discuss clinical, pastoral, and future research implications.

What Does it Mean to be a Common Factors Informed Family Therapist?

The common factors paradigm in couple and family therapy has gained popularity over the past several decades, leading many therapists to refer to themselves as common factors family therapists. Despite this, no consensus exists on what it means to be a common factors family therapist, or if such a designation even makes sense given that the common factors paradigm is not a model. Synthesizing the existing common factors literature, a case is made for the designation "common factors informed family therapist," and the following six core principles are outlined that characterize this designation: (1) sees overlap among theories; (2) passionate about theory, not a theory; (3) client centered; (4) monitors hope and the therapeutic alliance; (5) views clients as people rather than objects; and (6) prioritizes healing over therapy. Each of the concepts is discussed in depth, and clinical implications are provided.

El paradigma de factores comunes en la terapia de parejas y familiar ha cobrado popularidad en las últimas décadas, haciendo que muchos terapeutas se refieran a sí mismos como terapeutas de factores comunes. A pesar de esto, no hay un consenso acerca de qué significa ser un terapeuta de factores comunes, o si dicha designación realmente tiene sentido, dado que el paradigma de factores comunes no es un modelo. A base de una síntesis de la literatura de factores comunes existente, se aboga por la designación "terapeuta familiar informado por factores comunes", y se esbozan seis principios fundamentales que caracterizan esta designación; 1) ve que las teorías se entrecruzan; 2) apasionado por lo teórico, no por una teoría; 3) centrado en los clientes; 4) está pendiente de la esperanza y la alianza terapéutica; 5) ve a los clientes como personas en vez de objetos; y 6) se preocupa más por la sanación que por la terapia. Se discute cada concepto a profundidad y se proporcionan las implicaciones clínicas.

Nurturing Nature: Exploring Ecological Self-of-the-Therapist Issues.

Much has been written about the systemic effects of families and culture on individual well-being. Seldom discussed, however, are the systemic effects of our relationship with the larger ecological system in which all families and cultures are embedded. A case is made for the importance of nature in family therapy. Furthermore, before therapists can effectively address ecological issues in therapy, they need to address various ecological self-of-the-therapist issues that will influence their clinical practice. A series of questions are asked to help guide therapists in this exploration, and practical suggestions for incorporating nature into MFT clinical practice, training, and research are made.

Strengthening the systemic ties that bind: integrating common factors into marriage and family therapy curricula.

Specific models guide the training of marriage and family therapists (MFTs) as they offer both structure and organization for both therapists and clients. Learning models may also benefit therapists-in-training by instilling confidence and preventing atheoretical eclecticism. The moderate common factors perspective argues that models are essential, but should not be taught as "the absolute truth," given there is no evidence for relative efficacy of one empirically validated model versus another, and no single model works in all instances. The following article provides a blueprint for infusing a common factors perspective into MFT programmes by reviewing innovations in course design, outlining specific teaching strategies, and highlighting potential implementation challenges.

Targeting Threats to the Therapeutic Alliance: A Primer for Marriage and Family Therapy Training.

Although theory and research highlight the importance of the client-therapist relationship, marriage and family therapy (MFT) training has historically centered on specific models, consisting of proprietary language and techniques, instead of common factors like the therapeutic alliance. In this article, we begin by making an argument for explicitly focusing on the therapeutic alliance in MFT training programs. Next, we highlight common alliance threats experienced by both faculty members and student therapists. We then integrate research-informed principles with clinical wisdom to outline specific recommendations and concrete skill-building exercises for MFT educators and supervisors to use with their students to address these threats and advance training on the therapeutic alliance.

The divide between "evidenced-based" approaches and practitioners of traditional theories of family therapy.

Evidenced-based approaches continue to grow in the field of family therapy. However, practicing family therapists do not always embrace these approaches. In this article, we explore factors contributing to practitioners' concerns with evidence-based treatments and suggest a broader, more clinically palatable view of evidenced-based treatment. We also suggest how family therapy researchers, practitioners, and educators might begin to close the researcher-clinician divide in the best interest of all concerned.

Therapist-worldview matching: not as important as matching to clients.

In this essay, we respond to Simon's article (2012). We discuss our view that therapy works best when therapists can match therapeutic interventions to the worldview of clients. We see this matching to client worldview as rooted in research evidence, and we suggest that therapists can practice authentically and effectively using more than one divergent therapy approach. We conclude the paper by pointing out points of disagreement we have with Simon's use of Davis and Piercy's (Journal of Marital and Family Therapy, 2007a; 33, 298; Journal of Marital and Family Therapy, 2007b, 32, 515) study, a study Simon uses to ground his arguments.

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.

Common pitfalls of beginning therapists utilizing enactments.

Empirical data, clinical observation, and theoretical rationales support use of enactments as a fundamental mechanism of change in relationship therapies. Yet beginning therapists may lack an adequate conceptual framework and operational training essential to effectively utilize enactments. Inadequate training may contribute to ineffective execution, and in turn to negative results, which could lead to abandonment of enactments. This study sought to identify proficiencies and nonproficiencies of beginning therapists in conducting enactments. Twenty beginning therapists from three Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE)-accredited programs were briefly trained in an indirect therapy style that incorporates enactments. Twenty-six therapist enactments were coded using a comprehensive observational measure designed to assess proficiencies and nonproficiencies in executing enactment phases, component tasks, and subcomponent operations. Results suggest that beginning therapists struggle with numerous clinical operations conceptually linked to the successful engagement of relationships in marriage and family therapy. In light of these findings, specific recommendations for additional enactment training in COAMFTE-accredited programs are offered.

Is who delivers the treatment more important than the treatment itself? The role of the therapist in common factors.

In this article, we discuss the role of the therapist in change in couple and family therapy. We argue that the therapist is a key change ingredient in most successful therapy. We situate our discussion in the common factors debate and show how both broad and narrow common factor views involve the therapist as a central force. We review the research findings on the role of the therapist, highlight the strengths and weaknesses of this literature, and provide directions for future research. We then use this review as a foundation for our recommendations for theory integration, training, and practice.

What clients of couple therapy model developers and their former students say about change, part I: model-dependent common factors across three models.

Some researchers have hypothesized that factors common across therapy models are largely responsible for change. In this study we conducted semi-structured, open-ended qualitative interviews with three different MFT model developers (Dr. Susan M. Johnson, Emotionally Focused Therapy; Dr. Frank M. Dattilio, Cognitive-Behavioral Therapy; and Dr. Richard C. Schwartz, Internal Family Systems Therapy), Dr. Johnson and Dr. Schwartz's former students, and each of their former clients who had terminated therapy successfully. We examined possible common factors in our qualitative data analysis. Common factors fell into two main categories of model-dependent factors and model-independent factors. This article-the first of two-reviews the model-dependent common factors, common elements found across three distinct therapies. They include common conceptualizations, common interventions, and common outcomes, each with several subcategories. We discuss the clinical, training, and research implications of the results.

What clients of couple therapy model developers and their former students say about change, part II: model-independent common factors and an integrative framework.

Proponents of the common factors movement in marriage and family therapy (MFT) suggest that, rather than specific models of therapy, elements common across models of therapy and common to the process of therapy itself are responsible for therapeutic change. This article-the second of two companion articles-reports on a study designed to further investigate common factors in couple therapy. We used grounded theory techniques to analyze data from interviews with MFT model developers Dr. Susan M. Johnson, Dr. Frank M. Dattilio, Dr. Richard C. Schwartz, former students of Dr. Johnson and Dr. Schwartz, and each of their clients who had been successful in couple therapy. This article reports model-independent variables, that is, general aspects of therapy that are not directly related to the therapist's model. Model-independent categories include client variables, therapist variables, the therapeutic alliance, therapeutic process, and expectancy and motivational factors, each with several subcategories. We also present a conceptual framework that outlines how model-dependent and model-independent common factors may interact to produce change. We discuss our findings and proposed framework in relation to the current common factors literature in psychology and MFT. We also discuss clinical, training, and research implications.

Factors associated with former smokers among female adolescents in rural Virginia.

We examined multiple ecological factors (individual, family, peer, school, and community) associated with female adolescent former smokers (FS), current smokers (CS), and never smokers (NS) in a sample of 2029 seventh to twelfth grade girls living in a rural area of Virginia. We were particularly interesting in examining variables related to FS. Compared to CS, FS reported lower levels of delinquency, less coping by taking drugs, less availability of cigarettes, and less alcohol and marijuana use. They also reported less depression, fewer suicidal thoughts, and fewer suicide attempts than CS. FS reported spending more time in community clubs, had higher self-esteem, obtained higher grades, had more parental monitoring, more parent attachment, and more school attachment than CS. Logistical regression analysis predicting current or former smoking status revealed significant effects on coping by taking drugs, alcohol use, depression, grades, parental monitoring, and perceived availability of cigarettes. The findings have implications for smoking intervention programs with adolescent girls in rural areas.

Enacting relationships in marriage and family therapy: a conceptual and operational definition of an enactment.

Enactments are a potential common clinical process factor contributing to positive outcomes in many relational therapies. Enactments provide therapists a medium for mediating relationships through simultaneous experiential intervention and change at multiple levels of relationships--including specific relationship disagreements and problems, interaction process surrounding these issues, and underlying emotions and attachment issues confounded with those problems. We propose a model of enactments in marriage and family therapy, consisting of three components--initiation operations, intervention operations, and evaluation operations. We offer a conceptual framework to help clinicians know when and to what purpose to use this model of enactments. We provide an operational description of each component of an enactment, exemplifying them using a hypothetical clinical vignette. Directions for future research are suggested.