"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.

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.

Clients' perceptions of marriage and family therapists' way-of-being: a phenomenological analysis.

Previous research highlights the influence of therapist factors on treatment outcomes. One therapist factor proposed as fundamental to the process of therapy is the therapist's way-of-being, a relational concept that refers to how the therapist regards a client-either as a person or object (Fife et al., [2014] Journal of Marital and Family Therapy, 40, 20-33). Although this case has been made conceptually, there is little empirical research on therapists' way-of-being with clients. The primary purpose of this research is to investigate clients' perceptions of their therapists' way-of-being. Utilizing a common factors perspective, the study seeks to explore: (a) how clients experience their therapists' way-of-being and (b) the influence therapists' way-of-being has on clients' engagement. Phenomenological methods were used to gain a nuanced understanding of the phenomenon. Qualitative data were collected through semi-structured face-to-face interviews with clients (N = 10) who received individual therapy from a marriage and family therapist. Results were organized into two main themes: core tenets (attunement, congruency, and aligning with clients) and operational tenets (providing affirmation and validation, balancing flexibility and structure, and accomplishing goals). Findings are used to make a case for adding the concept of way-of-being as an overarching construct for several well-established therapist factors. Clinical and training implications are discussed.

Predicting Engagement in Electronic Surveillance in Romantic Relationships.

The Internet is a common medium through which people engage in interpersonal electronic surveillance (IES) of one another. We know little empirically about what predicts IES in romantic relationships. The present study expands on factors identified in previous studies (including demographic characteristics, relational characteristics, and other psychosocial variables) to predict surveillance in romantic relationships. Internet users in established romantic relationships (n = 259) completed inventories on the frequency of surveillance behavior, relationship variables, demographic variables, and Internet usage variables. Hierarchical regression was applied to understand relationships between these behaviors and surveillance. The regression supported that relationship variables and Internet use variables significantly predicted IES in romantic relationships. These findings further our understanding of the Internet to surveil partners.

A University-Based Transdisciplinary Approach to Mental Health Workforce Shortages.

The purpose of this paper is to describe the development, actions, and evaluation of a university-based, transdisciplinary coalition so that the model may be replicated in other university or multidisciplinary systems. The University of Nevada Las Vegas (UNLV) Mental and Behavioral Health Coalition addresses Nevada's workforce shortages through multi-disciplinary faculty collaboration among seven training programs at UNLV that produce mental health professionals. The coalition's collaborative approach to solution-generating work has served as a catalyst for professional integration in the community as a whole.

A Framework of Interprofessional Telebehavioral Health Competencies: Implementation and Challenges Moving Forward.

Interprofessional telebehavioral health (TBH) competencies have been developed to standardize training and improve the quality of TBH care. The seven identified interprofessional TBH competency domains and three levels of expertise (novice, proficient, and authority) are briefly described. More in depth descriptions and examples of several of the competency domains are presented to illustrate what the competencies look like in practice. Some of the challenges faced in using such a competency framework are discussed.

How many bytes does it take? A content analysis of cyber issues in couple and family therapy journals.

In the fifteen years since the explosion of the Internet, using cyber technology for work and social functions has exponentially increased. Yet, questions around how to manage such changes remain elusive in family therapy literature. In this investigation, we conducted a content analysis to determine to what extent marriage/couple and family therapy (M/CFT) journals have responded to the integration of the Internet in couple and family life. We found 79 of 13,274 articles across seventeen journals focused on the Internet in some capacity. Implications for clinical practice, training, and future research are discussed.

Essential elements of Internet infidelity treatment.

As the worldwide usage of the Internet tops 1.6 billion people, problems related to its use such as online Infidelity are becoming widespread issues for couples and, consequently, for their therapists. The purpose of this qualitative study was to understand how practicing therapists treat Internet infidelity through exploring the basic themes used in Internet infidelity treatment. We conducted in-depth interviews of 15 therapists with experience in treating Internet infidelity. Our findings indicate that therapists go through a variety of steps in treatment, including: (a) develop physical boundaries, (b) develop psychological boundaries, (c) manage accountability, trust, and feelings, (d) increase client awareness around etiology of the Internet relationship, (e) assessment of the couple's context and readiness for change, (f) assess the presence of unique circumstances, and (g) work toward forgiveness. Implications and future research are discussed.

Technology, relationships, and problems: a research synthesis.

The advances in technology alter the ways we interact with each other. For some, the use of technology can facilitate a relationship; for others, technology can complicate aspects of a relationship. The purpose of this research synthesis is to summarize current research exploring the ways in which technology impacts relationships negatively. Eight studies were reviewed across the following areas: preoperational definitions, sample, methodology, control of extraneous variables, causal influence, generalizability, validity of statistical findings, and conclusions. Implications for authors, researchers, and therapists working with couples and families struggling with technology issues are discussed.

Therapists' assessment and treatment of internet infidelity cases.

In this study, we investigated through an Internet survey of 508 practicing marriage and family therapists which treatment decisions varied by gender of the client and background variables of therapists. The subjects responded to several typical Internet infidelity scenarios. We varied the gender of the person initiating the infidelity for half of one sample. We also asked the family therapy participants to respond to how they might assess and treat each presenting problem. They also evaluated problem severity, prognosis of the case, number of sessions necessary for treatment, and the extent to which a therapist would focus individually or relationally. Results indicate that there were differences in how therapists assessed and treated clients based on client gender, therapists' age, therapists' gender, how religious therapists reported they were, and the extent of therapists' personal experience with infidelity.

Factors influencing student selection of marriage and family therapy graduate programs.

To understand which factors students consider most important in choosing a marriage and family therapy (MFT) graduate program and how programs met or did not meet these expectations of students over the course of graduate study, we conducted an online mixed-method investigation. One hundred twelve graduate students in Commission on Accreditation for Marriage and Family Therapy Education-accredited programs responded to an online survey assessing what factors led them to select a specific graduate program in MFT. In the quantitative portion, students ranked each factor (personal fit, faculty, funding, research, clinical work, and teaching) as well as characteristics of each factor in relation to its importance in their selection of an MFT program. Additionally, students indicated to what level their programs meet their expectations. In the qualitative portion, students described how they believed their chosen program was or was not meeting their expectations. Both doctoral and master's students ranked personal fit as the top factor affecting their choice of graduate program in MFT, but they differed on the characteristics of each of these factors and their importance in selecting an MFT program. Implications for this research include program evaluation and program advertising, and are consistent with the scientist-practitioner model.

A systematic research synthesis of EMDR studies: implementation of the platinum standard.

Eye movement desensitization and reprocessing (EMDR) is a psychological treatment method used primarily for people who have experienced trauma. This article provides a systematic research synthesis of EMDR studies targeting trauma symptomatology published between 1997 and 2003. This synthesis builds on the Revised Gold Standard (RGS) as a guide to evaluate empirical EMDR studies. Modifications and additions to the RGS criteria are proposed. The resulting standard is referred to as the Platinum Standard (PS). Sixteen EMDR studies are reviewed and critiqued using the PS criteria. None of the studies reviewed met full PS criteria. The mean score for the studies on the PS was 8.28, with 9 of the studies exceeding the mean. The review calls for researchers to employ more rigorous research designs for EMDR effectiveness using PS criteria. Implications for practice, policy, and research are discussed.