25 years of systemic therapies research: progress and promise.

OBJECTIVE: In this article we describe and assess the state of the science on systemic psychotherapies. In the quarter century since the first issue of Psychotherapy Research was published, considerable progress has been made. There is an increasingly solid evidence base for systemic treatments, which includes a wide range of approaches to working conjointly with couples and families. Moreover, there are exciting new developments that hold promise for explicating the dynamic processes of therapeutic change in couple and family systems. METHOD: We begin by explaining how we view "systemic therapies" as different from individual approaches and then summarize what we have learned in the past 25 years about this set of treatments, how we have learned it, and what we have yet to learn. RESULTS AND CONCLUSIONS: We consider current trends in research on outcomes and change process mechanisms, and end with speculations about what lies ahead in the interrelated domains of systemic research and practice.

Purposes, diversities, and futures in MFT doctoral education.

Doctoral education in marital and family therapy (MFT) plays a crucial role in the future of the field. In this article, I write about the purposes, diversities, and futures of MFT doctoral education from the perspective of having hired 18 full-time MFT faculty over the last 13 years. I argue that the field needs well-rounded doctoral-level academics and clinicians who have a solid understanding of the foundations of the field and have mastery around theory, clinical practice, and scholarship in order to advance the profession of Marriage and Family Therapy.

Internships for future faculty: meeting the career goals of the next generation of educators in marriage and family therapy.

A key component of a doctoral education in marriage and family therapy (MFT) is the completion of an internship. Virtually all MFT doctoral internships are focused on advanced clinical practice and often are located in agencies unconnected with an academic setting. This article describes an MFT doctoral internship specifically designed to foster the skills needed as a faculty member. The primary purpose of this "future faculty" internship is to expose doctoral interns to faculty life, including participation in graduate teaching, clinical supervision, research, and faculty service-while still meeting typical clinical requirements. Results of semistructured qualitative interviews with five doctoral interns associated with the site are reported. Guidelines for the development of other doctoral internships designed for future MFT faculty members are discussed.

[Sex therapy for male sexual dysfunction]. / Sexualtherapie bei sexuellen Funktionsstörungen des Mannes.

A high prevalence and incidence of sexual dysfunctions as well as the availability of orally effective medications cause a rising interest in professional help. In diagnosing and treating sexual disorders, a holistic, biopsychosocial understanding of sexuality and a thorough analysis of the specific needs of the couple are of the utmost importance. Furthermore, the typical physician-patient relationship has to be transformed into a physician-couple relationship wherever possible. Sex therapy, then, focuses on the universal psychosocial fundamental needs and their relevance for the complaints of the couple. In this way the main focus of attention is shifted from the sexual dysfunction to the communicative meaning of sexuality within the relationship and to the quality of the partnership as a whole. Thus the sexual problem is put into a new perspective and sexual functions are relieved from the pressure of performance anxiety. Simultaneously intimacy and mutual satisfaction are promoted. The possibility of obtaining an additional qualification in sexual medicine (since 1997 in postgraduate, curricular trainings) is offering new opportunities for urologists to integrate aspects of sexual medicine into their clinical practice and thus to propose a more extensive form of therapy to their patients. This paper reflects the process of this integration, illustrating it with respective case reports; it stresses the necessity of a holistic approach to the treatment of sexual dysfunctions, also in regard to the economic advantages of a biopsychosocially oriented sex therapy.

Studying marriage and family therapists in the 21st century: methodological and technological issues.

In this article, I present data from two waves of research on demographic characteristics and practice patterns of marriage and family therapists (MFTs) conducted in 2000 and 2002. The research focuses on the methodological and technological issues in studying this population. Specifically, an online survey with MFTs obtained lower response rates and was therefore more expensive relative to phone and mail methods. Questions about evidence-based therapies (EBTs) were asked two different ways with significantly different results based on how the questions were phrased. A discussion of the relative advantages and disadvantages of using different survey methodologies and consideration of issues pertinent to studying EBTs are included.

Estimating the cost of direct reimbursement of marriage and family therapy under Medicare.

In this article, we investigated the estimated cost to the Medicare program for covering psychotherapy services provided by marriage and family therapists (MFTs). Historical trends were identified by using psychotherapy cost and utilization data for the years 1999-2001. Using these trends, projections for the years 2002-2006 were made with MFTs included as providers. Employing this methodology, the 5-year estimated net increase and gross increase in cost due to the provision of psychotherapy services by MFTs was found to be approximately dollar 10.5 million (or dollar 2.1 million per year) and dollar 13.9 million (or dollar 2.8 million per year), respectively. This represents an increase of less than 1/2 of 1% of the Medicare mental health budget, and less than .0015% of Medicare expenditures overall.

The revolution in couple therapy: a practitioner-scientist perspective.

This article offers an overview of the expanding field of couple therapy, focusing on what the author considers to be new and even revolutionary in this field. In terms of outcome research, this article suggests that differential treatment effects are discernable. Emotionally focused therapy (EFT) appears to demonstrate the best outcomes at present. The most significant differences between research studies and everyday clinical practice may be the levels of therapist supervision rather than the essential nature of clients. The manualization of treatment is also viewed positively in this review. Areas of growth are the mapping of the territory of distress, understanding the process of change, couple therapy as an effective intervention for "individual" disorders, and the integration into couple therapy of clinical research, such as the research on gender and responses in therapy, and research on adult attachment. Practitioner-scientists can contribute to this evolving field by systematic observation and by reminding researchers of the need for clinical relevance. Couple therapy is now integrating description, prediction and explanation. As a result, theory, practice and systematic investigation are beginning to create a coherent whole.

Marital therapy in the treatment of depression: toward a third generation of therapy and research.

Two generations of outcome research demonstrate the potential efficacy of marital therapy in the treatment of depression. After reviewing treatment outcome studies on marital therapy for depression, we examine basic research linking aspects of the marital relationship to depressive symptoms. In doing so, we highlight a number of theoretical perspectives and research findings that can inform work with couples in which one spouse is depressed. Finally, we identify potential innovations that may lead to a third generation of marital interventions for depression and several avenues of inquiry for a third generation of outcome research on marital therapy for depression.