The Therapist's Role in Effective Marriage and Family Therapy Practice: The Case for Evidence Based Therapists.

In this paper we argue that the therapist is a crucial change variable in psychotherapy as a whole and in couple, marital, and family therapy specifically. Therapists who work with complex systems require more skills to negotiate demanding therapy contexts. Yet, little is known about what differentiates effective couple, marital, and family therapists from those who are less effective, what innate therapy skills they possess, how they learn, and how they operationalize their knowledge in the therapy room. We discuss the need to emphasize evidence based therapists (as opposed to therapies), and implications of the importance of the role therapists for training, practice, research priorities, and policy.

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.

Role-exit theory and marital discord following extended military deployment.

PURPOSE: The purpose of this study was to determine the effectiveness of applying role-exit theory concepts in the counseling of military couples experiencing marital discord following extended periods of deployment. DESIGN AND METHODS: Qualitative case-study methodology was utilized to assess, diagnose, and treat 10 military couples using a framework based on role-exit theory. FINDINGS: Six couples self-reported improvement in the marital relationship following this counseling approach. PRACTICE IMPLICATIONS: Role-exit theory based counseling may benefit other couples who experience marital discord due to role issues. The clinical nurse specialist might consider this paradigm when working with couples in marital therapy.

The development of core competencies for the practice of marriage and family therapy.

In response to a series of national policy reports regarding what has been termed the "quality chasm" in health and mental health care in the United States, in January 2003, the American Association for Marriage and Family Therapy convened a task force to develop core competencies (CC) for the practice of marriage and family therapy (MFT). The task force also was responding to a call for outcome-based education and for the need to answer questions about what marriage and family therapists do. Development of the CC moves the field of MFT into a leading-edge position in mental health. This article describes the development of the CC, outcomes of the development process for the competencies, and recommendations for their continued development and implementation.

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.

Self-expansion as a mediator of relationship improvements in a mindfulness intervention.

In a recent randomized controlled trial, couples participating in a mindfulness-based relationship enhancement program demonstrated significant improvements in relationship satisfaction and relationship distress (Carson, Carson, Gil, & Baucom, 2004). Here we report on a multiple mediation analysis of these couples' improvements. Potential mediators included measures of couples' engagement in exciting self-expanding activities, couples' ability to accept one another's difficult characteristics, and individual partners' ability to relax. Results indicate that to a large extent, the mindfulness-related relationship improvements can be attributed to partners' sense that they were participating in exciting self-expanding activities together during the course of the intervention. The implications of these findings for future mindfulness research are discussed.

The Marriage and Family Therapy Practice Research Network (MFT-PRN): Creating a More Perfect Union Between Practice and Research.

This article describes the Marriage and Family Therapy Practice Research Network (MFT-PRN). The MFT-PRN is designed to build a professional community based on practice-informed research and research-informed practice, increase the diversity of participants in MFT research, and unify researchers and clinicians. Clinics choose measures from a list that best represent their clinic needs. Clients' outcomes are assessed regularly, and therapists receive immediate graphical feedback on how clients are progressing or digressing. Data are pooled to create a large and diverse database, while improving client outcomes. We will discuss advantages of the MFT-PRN for researchers, therapists, clients, and agencies, and provide one model that we hope will inform other collaborative clinical-research models in the field of marriage and family therapy. Video Abstract is found in the online version of the article.

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.

When approved is not enough: development of a supervision consultation model.

The dramatic increase in the literature that addresses family therapy training and supervision over the last decade has been predominantly in the area of theory, rather than practice. This article describes the development of a meta-supervisory learning context for approved supervisors and provides examples of interactions between supervisors that subsequently influenced both therapy and supervision. We delineate the assumptions that inform our work and offer specific guidelines for supervisors who wish to implement a similar model in their own contexts. We provide suggestions for a proactive refiguring of supervision that may have profound effects and benefits for supervisors and supervisees alike.

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.

Exploring programmatic moderators of the effectiveness of marriage and relationship education programs: a meta-analytic study.

This study uses meta-analytic methods to explore programmatic moderators or common factors of the effectiveness of marriage and relationship education (MRE) programs. We coded 148 evaluation reports for potential programmatic factors that were associated with stronger intervention effects, although the range of factors we could code was limited by the lack of details in the reports. Overall, we found a positive effect for program dosage: moderate-dosage programs (9-20 contact hours) were associated with stronger effects compared to low-dosage programs (1-8 contact hours). A programmatic emphasis on communication skills was associated with stronger effects on couple communication outcomes, but this difference did not reach statistical significance for the relationship quality/satisfaction outcome. There was no evidence that institutionalized MRE programs (formal manuals, ongoing presence, formal instructor training, multiple evaluations) were associated with stronger effects. Similarly, there was little evidence of differences in program setting (university/laboratory vs. religious). We discuss possible explanations for these findings and implications for program design and evaluation.

The mental health recovery movement and family therapy, part I: consumer-led reform of services to persons diagnosed with severe mental illness.

In 2004, the U.S. Department of Health and Human Services issued a consensus statement on mental health recovery based on the New Freedom Commission's recommendation that public mental health organizations adopt a "recovery" approach to severe and persistent mental illness, including services to those dually diagnosed with mental health and substance abuse issues. By formally adopting and promoting a recovery orientation to severe mental illness, the United States followed suit with other first-world nations that have also adopted this approach based on two decades of research by the World Health Organization. This movement represents a significant paradigm shift in the treatment of severe mental health, a shift that is more closely aligned with the nonpathologizing and strength-based traditions in marriage and family therapy. Furthermore, the recovery movement is the first consumer-led movement to have a transformational effect on professional practice, thus a watershed moment for the field. Part I of this article introduces family therapists to the concept of mental health recovery, providing an overview of its history, key concepts, and practice implications. Part II of this article outlines a collaborative, appreciative approach for working in recovery-oriented contexts.

The mental health recovery movement and family therapy, part II: a collaborative, appreciative approach for supporting mental health recovery.

A continuation of Part I, which introduced mental health recovery concepts to family therapists, Part II of this article outlines a collaborative, appreciative approach for working in recovery-oriented contexts. This approach draws primarily upon postmodern therapies, which have numerous social justice and strength-based practices that are easily adapted in recovery-oriented contexts. The model outlined in this article includes an overview of the recovery partnership (i.e., therapeutic relationship), mapping recovery (i.e., assessment and case conceptualization), recovery planning (i.e., treatment planning), facilitating recovery (i.e., intervention), accessing resources (i.e., case management), recovery maintenance, and service contexts as well as a case study.

The Families and Democracy and Citizen Health Care Project.

This article describes and updates the work of the Families and Democracy and Citizen Health Care Project, which engages with community concerns in order to effect change on many system levels. The project draws on family therapy's tradition of interest in larger social issues and adds democratic public theory and community organizing strategies. Since 1999 we have developed 14 citizen initiatives with a wide range of groups on a diverse set of problem areas. We describe the overall project and several of its initiatives, we address research and evaluation issues, and we outline opportunities for marriage and family therapists to learn how to do this work in their own communities.

Constructing a sex and marital therapy frame: ways to help couples deconstruct sexual problems.

It has been pointed out that an integration of the fields of marital and family therapy and sex therapy is needed. This paper proposes a model for the integration of sex therapy and marital therapy. Recently, social constructionism has made its way into the marital and family therapy literature. Using social constructionist notions, the present paper proposes an alternative perspective to the traditional sex therapy models--one that incorporates a constructionist therapeutic stance utilizing the notions of sexual meaning systems and sexual scripts. In so doing, an integrated model of sex and couple therapy is presented.