Fidelity Assessment of the Treatnet family (TF): A family-based intervention for adolescents with substance use disorders and their families.

INTRODUCTION: In transporting family-based interventions to community settings, establishing and maintaining fidelity to intervention is important. This exploratory study was implemented in the framework of a United Nations Office on Drugs and Crime (UNODC) global programme on Drug Dependence Treatment and Care. It is the first to examine an evidence-informed family-based intervention ("Treatnet Family"; TF) adherence for the treatment of adolescents with substance use disorders (SUD) among practitioners in community settings in Jakarta, Indonesia. METHOD: Twenty-three practitioners at five community-based counselling centres were trained in Treatnet Family and delivered it to 19 adolescents with SUD and their family members over a 6-week period. One of the five local Treatnet Family-trained supervisors randomly selected one session of the family-based intervention (TF) and observed the extent to which the practitioner's adhered to the TF manual. RESULTS: According to the supervisors' observation, all the practitioners used the Treatnet Family core skills such as positive reframing, positive relational reframing, perspective taking, relational questions, and going with resistance. There was a high level of agreement between practitioners' and supervisors' rating on the practitioners' use of specific therapeutic skills as measured using the Inventory of Therapy Techniques (ITT). CONCLUSION: Results suggest that Treatnet Family can be delivered with adherence by practitioners in community-based settings.

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.

A Virginia Tech MFT ethics class reflects on the shootings at Virginia Tech.

The authors of this article include the professor and most of the students in a doctoral course on marriage and family therapy ethical and professional issues that met the semester that a disturbed student shot and killed 32 Virginia Tech students and faculty before killing himself. In this article, we reflect through short essays on issues related to the tragedy, ethics, and recovery.

A careful balance: multinational perspectives on culture, gender, and power in marriage and family therapy practice.

In this study, we examined how marriage and family therapists from various countries and diverse cultural backgrounds address the intersection of gender, power, and culture in therapy. Twenty participants from 15 countries responded to an Internet survey that included several hypothetical, clinical vignettes not associated with any one particular culture or nationality. Participants selected a vignette based on its similarity to clinical situations they face in practice within their cultural contexts, and provided information about their conceptualizations of gender, culture, and power, along with treatment recommendations. We analyzed data using analytic induction and constant comparison methods. Results indicate the careful balance with which the participants work to engage clients in therapy, respect cultural values and practices, and promote equitable gender relationships.

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.

Exploring Partner Intimacy Among Couples Raising Children on the Autism Spectrum: A Grounded Theory Investigation.

In this study, we explored how couples raising children with autism spectrum disorder negotiate intimacy, including what contextual and temporal factors influence these processes. We conducted conjoint interviews with 12 couples, employing grounded theory methodology to collect and analyze the data. Our results indicated that fostering intimacy in these couples' relationships involves partners working together to make key cognitive and relational shifts. Couples are aided or hindered in making these shifts by the degree to which they experience various contextual and environmental factors as resources or roadblocks. We also found that intimacy is not a fixed point at which couples one day arrive, but is an iterative process taking place over time and requiring work to develop and maintain.

Most and Least Meaningful Learning Experiences in Marriage and Family Therapy Education.

Marriage and family therapy educators increasingly emphasize training competencies. What we know less about is what makes family therapy education meaningful to marriage and family therapy (MFT) graduate students and what does not. In this study, through an Internet survey, we explored the most and least meaningful learning experiences of 68 MFT graduate students and recent graduates of Commission on Accreditation for Marriage and Family Therapy Education-accredited programs. We used thematic analysis to identify and illustrate resulting themes, which included the importance of experiential and personal components to learning, the professor-student alliance, tying theory to practice, and the experiences of students with their clients, among others. We discuss the implications of these findings to support family therapy education and offer tentative suggestions for formative discussions both within and across programs. Video Abstract is found in the online version of the article.

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.

Aesthetic forms of data representation in qualitative family therapy research.

In this article we provide a rationale for using alternative, aesthetic methods of qualitative representation (e.g., creative writing, art, music, performance, poetry) in qualitative family therapy research. We also provide illustrative examples of methods that bring findings to life, and involve the audience in reflecting on their meaning. One problem with such forms of data representation has been that, until recently, there have not been standards with which to evaluate them. We summarize evolving standards and explain when the forms are appropriate and when they are not. We also address issues of legitimacy and conflicting standards held by others.

Mindfulness-based relationship education for couples expecting their first child--part 1: a randomized mixed-methods program evaluation.

This article is Part 1 of a two-part series, in which we report on our evaluation of a mindfulness-based relationship enhancement program for couples who are expecting their first child. In this mixed-methods randomized clinical trial, we assigned 33 couples to the 4-week Mindful Transition to Parenthood Program treatment group (n = 16 couples) or to a waitlist control condition (n = 17 couples). Men in the treatment group significantly improved in relationship satisfaction, mindfulness, and negative affect; women had no significant treatment effects. Small to large effect sizes were present for treatment group men and women in multiple areas. Mixed-methods analyses demonstrated that this intervention may be especially helpful for men because of differences in social support needs, effects of program enrollment, and relational processes in the prenatal period.

Mindfulness-based relationship education for couples expecting their first child-part 2: phenomenological findings.

This phenomenological study is the second phase of a larger mixed methods study of a relationship-enhancement program for couples expecting their first child (see Gambrel & Piercy, this issue). The 4-week Mindful Transition to Parenthood Program uses mindfulness practices and interpersonal activities to develop skills of internal and interpersonal attunement. Based on semi-structured interviews with thirteen couples, four overarching themes emerged: (a) positive changes for self, (b) improvements in couple relationship, (c) more prepared for baby, and (d) male involvement. Participants stated that the program increased their acceptance and awareness, deepened connections with their partners, and led them to be more confident about becoming parents. Male participants felt they became more identified as fathers. The authors discuss the clinical implications of these findings.

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.

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.