A primer on sleep for MFTs: Implications and practical considerations

Despite many marriage and family therapists (MFTs) utilizing the Biopsychosocial-Spiritual (BPSS) framework in assessment and treatment, there is still a lack of education on sleep and the implications for mental, emotional, and relational health. Newer research within many fields highlights the far-reaching spillover effects of short or poor-quality sleep that can affect our clients. MFTs need to know how to assess, how to provide proper psychoeducation, how to apply this knowledge in clinical settings, and how to collaborate with other healthcare providers. As such, the purpose of this article is threefold: (a) review the biopsychosocial-spiritual importance of sleep; (b) equip MFTs with information on sleep assessment, how to identify situations for referral, and how to provide psychoeducation on sleep hygiene; and (c) review important considerations for research and practice for MFTs.

A call to action: Online learning and distance education in the training of couple and family therapists

Distance education in couple and family therapy (CFT) has grown in recent years; however, due to the COVID-19 pandemic, many CFT educators find themselves delivering emergency online education out of necessity and for the first time. Despite the growth of distance learning over the last decade, there is virtually no CFT scholarship on the topic. Comparable disciplines, including social work and professional counseling, are further along in researching distance learning. Outside of the counseling disciplines, there is also ample scholarship guiding the delivery of distance education. This article builds on the small body of CFT scholarship on technology in training and supervision, reviewing extant research on distance learning in social work and counselor education. Major themes in this research reveal opportunities and challenges associated with distance learning and offer guidance about ways that CFT education can evolve in order to effectively integrate technology and online learning into our educational landscape.

Integration of teaming therapy and mixed-reality simulation as remote learning modality for couple and family therapy graduate training programs

In response to COVID-19, a couple and family therapy (CFT) graduate training program integrated a teaming therapy model with virtual technology using mixed-reality simulation software. By utilizing teaming therapy--a model with strong roots in systemic theory and practice-- combined with cutting-edge simulation technology, this distance learning modality provides distinctly relational therapy supervision and training for students at a time when their internships sites are struggling to offer remote clinical services due to the pandemic. This integrative framework offers a high degree of both realism and safety, allowing experiential learning to be appropriately scaffolded for optimum creativity and engagement in an online setting. This paper describes the conceptual, systemic basis for the learning modality, steps for implementation, benefits of the model, and the authors plan for further evaluation.

The transition to teletherapy in marriage and family therapy training settings during COVID-19: What do the data tell us?

In the wake of the COVID-19 pandemic, little is known about how university training programs transitioned to teletherapy. This study describes the transition of two university marriage and family therapy (i.e., master's and doctoral) training clinics to teletherapy and presents preliminary analyses of the types of clients and cases that converted to teletherapy. A series of chi-square analyses, a t-test, a logistic regression model, and a multiple linear regression model were employed. Four key findings emerged: (1) most cases converted to teletherapy; (2) Hispanic ethnicity was the only demographic characteristic to significantly predict conversion to teletherapy; (3) individual cases were significantly more likely to convert to teletherapy than relational cases; and (4) the number of prior in-person sessions attended significantly predicted conversion to teletherapy. Teletherapy conversion implications are discussed across four systemic levels: client, student trainee, supervision, and larger systems.

The Experiences of Couple/Marriage and Family Therapists of color: A Survey Analysis

The family therapy literature documenting the experiences of couple/marriage and family therapists (C/MFTs) of color as a group is limited. The purpose of this study was to assess the status of C/MFTs of color in their clinical training programs, clinical work, and related areas of professional challenges and opportunities. Participants (N = 113) completed a one-time, anonymous electronic survey on SurveyMonkey consisting of demographic questions, closed- and open-ended questions about their experiences. Key findings are reported related to C/MFTs of color experiences in training programs, areas of professional need, and working with racial and/or ethnic minority clients. These findings shed light on how social justice principles and practices upheld in our field are experienced from the emic perspectives of C/MFTs of color. These voices help to broaden our understanding of how we might move forward in advocating for and advancing a more culturally responsive agenda within our profession.

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.

Sitting In: The Experience of Learning and Practicing Family Therapy through Being a Co-Therapist in Hong Kong

This article explores family therapy trainees' subjective experiences of working as cotherapists with a supervisory-level therapist in a Chinese context, regarding their perceptions of and positioning in it and also their opinions on the benefits and/or pitfalls of cotherapy. Individual interviews with a total of six cotherapists revealed three themes: (1) Cotherapy was perceived as an experiential learning journey that evolved from anxiety and excitement to empowerment and nurturing; (2) a collaborative master-apprentice relationship of openness, trust, and mutual respect was developed with both sides' interactive effort, which included common commitment and concern for the client, the supervisor's awareness and explicit address of the role hierarchy, principle setting prior to the cooperation, and honest pre- and-postsession sharing and discussion; (3) the dual-purpose supervisor-trainee cotherapy brought direct benefits for all involved parties and for others. The findings have useful implications for integrating treatment and training for optimal training/learning outcomes and for advancing knowledge transfer from senior to junior and from academia to the field, with reference to local cultural characteristics.

Behind the (Virtual) Mirror: Online Live Supervision in Couple and Family Therapy

Online therapy and supervision, a rapidly rising practice in couple and family therapy, has been the subject of a growing body of literature. From its early days, family therapy training has included live supervision, which has typically been conducted by a supervisor and a team of trainees situated on the other side of a one-way mirror. With the outbreak of the COVID-19 global pandemic, we-the staff of supervisors at the Barcai Institute in Tel Aviv, Israel-were compelled to find solutions to continue meeting with clients and to provide supervision for family therapy trainees. To this end, we have shifted our live supervision courses ("practicums") to the virtual arena, adapting the popular application "Zoom" into what we call "PractiZoom." Based on over 100 PractiZoom sessions conducted between March and May 2020, involving 14 supervisors and 28 therapists-in-training and their clients, the article reflects on this pioneering online practicum for the online live supervision of therapists with geographically distributed participants. In this article, we outline our operational methods and adaptations for conducting live behind-the-mirror supervision online. Following a short theoretical background, we outline the process of online live supervision, discuss our reflections and those of our trainees on the challenges and possibilities it poses, and offer a number of preliminary conclusions and recommendations.

Measuring the Effect of Sexual Health Education Training in Professionals: Structure of the Sexual Health Education for Professionals Scale (SHEPS) Among Marriage and Family Therapy Graduate Students

Marriage and family therapists and sexual health therapists are likely to receive training in graduate school that prepares them to encounter sexual concerns among clients, but there are few standard ways to assess the efficacy of this training. The Sexual Health Education for Professionals Scale (SHEPS) was developed to address this deficit. In this preliminary study, 163 marriage and family therapy graduate students completed the SHEPS prior to starting a graduate course in assessing and treating sexual concerns. Exploratory factor analyses indicate that the SHEPS subscales have good psychometric properties. The Skills and Knowledge subscales have factors labeled Typical Clients, Special Clients, Conservative Clients, and Ethically Complicated Clients. The Attitudes subscale had factors called General Sexual Attitudes, Valuing Sexual Health Training, Open to Providing Sexual Help, and Conservatism. This new instrument may be used to assess education and training of sexual health and marriage and family therapists. Larger sample sizes and longitudinal studies are needed in future.

Outsider Witness Groups as a Means of Professional Growth in Family Therapy Training: An Exploratory Qualitative Study

This exploratory qualitative study examines the experiences and meanings associated with family therapy trainees' participation in the narrative practice of Outsider Witness Groups (OWG). At the Barcai Institute in Tel Aviv, we incorporate OWGs into our live clinical supervision courses. In some sessions, we offer the families undergoing therapy the opportunity to listen to the reflections of the group of trainees regarding what they witnessed during the session. Twenty-nine family therapy trainees participated in the study in five focus group interviews. Analysis of the interviews yielded four core themes regarding the trainees' experiences: (i) Exploring the stance of the therapist; (ii) The art of listening; (iii) Reflection on hierarchy and boundary setting; and (iv) Negotiating self-disclosure. The findings indicate that family therapy trainees stand to benefit significantly in their professional journey, development, and growth from integrating OWG practices into their training. OWG fosters the development of critical reflectivity in trainees, including the deconstruction of common and taken-for-granted assumptions. It also fosters practices related to family therapy, and perhaps also to therapy in general. The findings also suggest that taking part in OWGs during training may contribute to family therapy trainees' development of critical reflectivity as a means of introducing a more critical and political approach to therapy and developing their own preferred stories as therapists.

The Digital Divide: Couple and Family Therapy Programs' Integration of Teletherapy Training and Education

The mental health field is increasingly integrating and growing a teletherapy presence, and couple and family therapists are uniquely situated to offer these services based on our history of innovative approaches to therapeutic services. To do so successfully, careful consideration of training and education must occur. To evaluate current teletherapy training and education opportunities of COAMFTE accredited couple, marriage, and family therapy programs, an inductive qualitative content analysis was conducted on the responses of 95 faculty at COAMFTE accredited programs. Findings indicate that more than two thirds of the participants were in favor of teletherapy integration in training programs; however, most programs currently do not offer such opportunities. Barriers that prevent such integration were highlighted as well as existing concerns to training graduate students in teletherapy. Implications for training programs, policies, and regulations are discussed.

The Condensed MFT Core Competencies: A Streamlined Approach for Measuring Student and Supervisee Learning Using the MFT Core Competencies

In this article, the authors present a condensed version of the Marriage and Family Therapy Core Competencies (MFT-CC), collapsing the original 128 MFT-CC to 16 using a qualitative research method. Educators, supervisors, and researchers can more easily and efficiently use the condensed MFT-CC to measure student and supervisee learning for accreditation and training. The 16 Condensed MFT-CC are mapped to the original MFT-CC, COAMFTE's Version 12 Foundational Curriculum Areas and the Association for Marital and Family Therapy Regulatory Boards 6 domains upon which the national exam is predicated.

Marriage and Family Therapy Students' Experience with Common Factors Training

With the increased empirical and theoretical support for common factors in the psychotherapy literature, marriage and family therapy (MFT) scholars have begun discussing the inclusion of common factors in MFT training. However, there is very little empirical research on common factors training or how to include common factors in MFT curricula. The purpose of this phenomenological study was to investigate MFT students' experience with common factors training. Seventeen master's degree students who received training in common factors participated in the study. Data was comprised of participants' journal reflections and focus group interviews on their experience learning about common factors and how this influenced their work with clients. Participants' responses to the training were overwhelmingly positive and highlighted the ways in which studying common factors enhanced their confidence, understanding of MFT models, conceptual abilities, and clinical practice. Additional results and discussion about incorporating common factors in MFT training are presented.

Integrating Spirituality into MFT Training: A Reflexive Curriculum and Qualitative Evaluation

When clients enter the therapy room they bring unique spiritual beliefs and values in with them; however, marital and family therapists (MFTs) often lack training to assist in this important area of diversity. Current training recommendations encourage therapists to explore their own spirituality to identify personal limitations that may occlude positive client outcomes; however very little information exists on the implementation and usefulness of this type of training. This article will describe a curriculum and report results from a qualitative study of students who participated in a reflexive spirituality practicum course offered in a COAMFTE accredited doctoral program at a private, religious institution. Through this, we hope to provide a training model to further spiritual integration activities in MFT.

The State of Sex Research in MFT and Family Studies Literature: A Seventeen-Year Content Analysis

The ability to conceptualize and treat sexual problems has been widely accepted as a crucial skill to master the MFT training. However, clients' sexual relationships are often ignored by clinicians because of a lack of experience or training, or personal discomfort. In this content analysis, we review sex and sex therapy research within MFT and family studies journals since the turn of the century. Of the 13,919 articles published within the 15 journals, 137 focused on sexuality or sex therapy. The articles were divided into five themes: sexual and relational health, sexual diversity, treatment and contributors of sexual dysfunction, sex therapy practices, and sexual education and development. Implications for clinical practices, sex therapy integration, and future research are discussed.

Integrative Systemic Therapy: Lessons on Collaboration and Training for the 21st Century

The field of couple, marital, and family therapy (CMFT) is at an important juncture of identity development and synthesis. Integrative Systemic Therapy (IST) is a problem-centered metaframeworks approach that meets the growing needs of family therapists working with diverse and complex family systems and restores the field to its original focus on collaboration. This paper describes the process by which IST developed featuring anecdotes from live interviews with the founders. We briefly outline IST's theoretical pillars and the essential way IST practitioners deliver treatment including a blueprint for therapy. Finally, we propose that IST is a comprehensive, systemic guide uniquely beneficial to CMFT training and discuss our approach to integrating IST into our training of students in a COAMFTE accredited program.

Expanding Systems Thinking: Incorporating Tools from Medical Sociology into MFT Education and Research

The field of marriage and family therapy has historically focused on dynamics within family systems, and at times the role of social and cultural factors external to the family. To date, however, little scholarship has examined how therapists themselves are embedded within a mental healthcare system. The purpose of this article is to demonstrate how structural components of the mental healthcare system shape the practice of therapy. We draw from the field of medical sociology to illustrate how three dominant structures-managed care, diagnosis, and evidence-based models-are intertwining and mutually reinforcing systems that have significant and long-term implications for systemic therapists and researchers. We recommend incorporating a sociological understanding of such structures into MFT education and research.

Measurement Training and Feedback System for Implementation of family-based services for adolescent substance use: protocol for a cluster randomized trial of two implementation strategies

BACKGROUND

This article describes a study protocol for testing the Measurement Training and Feedback System for Implementation (MTFS-I) and comparing two implementation strategies for MTFS-I delivery. MTFS-I is a web-based treatment quality improvement system designed to increase the delivery of evidence-based interventions for behavioral health problems in routine care settings. This version of MTFS-I focuses on family-based services (FBS) for adolescent substance use. FBS, comprising both family participation in treatment and family therapy technique use, have achieved the strongest evidence base for adolescent substance use and are a prime candidate for upgrading treatment quality in outpatient care. For FBS to fulfill their potential for widespread dissemination, FBS implementation must be bolstered by effective quality procedures that support sustainable delivery in usual care.

METHODS/DESIGN

Adapted from measurement feedback systems for client outcomes, MTFS-I contains three synergistic components: (a) weekly reporter training modules to instruct therapists in reliable post-session self-reporting on FBS utilization; (b) weekly mock session videos of FBS interventions (5-8 min) for supportive training in, and practice coding of, high-quality FBS; and (c) monthly feedback reports to therapists and supervisors displaying aggregated data on therapist-reported FBS use. MTFS-I is hosted online and requires approximately 20 min per week to complete. The study will experimentally compare two well-established implementation strategies designed to foster ongoing MTFS-I usage: Core Training, consisting of two 3-h training sessions focused on FBS site mapping, selecting FBS improvement goals, and sustaining MTFS-I, followed by routine remote technical assistance; and Core + Facilitation, which boosts Core Training sessions with collaborative phone-based clinical consultation and on-site facilitation meetings for 1 year to promote FBS goal achievement. The study design is a cluster randomized trial testing Core Training versus Core + Facilitation in ten substance use treatment clinics. Study aims will compare conditions on MTFS-I uptake, FBS delivery (based on therapist-report and observational data), and 1-year client outcomes.

DISCUSSION

Study contributions to implementation science and considerations of MTFS-I sustainability are discussed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03342872 . Registered 10 November 2017.

The effect of family-focused psychoeducational therapy for autism spectrum disorder children's parents on parenting self-efficacy and emotion

The purpose of this pilot study was to design, implement, and evaluate the family-focused psychoeducational therapy (FFPT) for autism spectrum disorder (ASD) family. In Phase I, 64 parents of ASD children (ASD-group) and 63 parents of typically development children (TD-group) were invited to investigate parenting self-efficacy and emotion at baseline. In Phase II, the 4-week of FFPT was offered for the ASD-group. Date was collected at baseline, post-intervention and one-month follow-up, using the parental self-efficacy, Self-Rating Anxiety Scale and Self-Rating Depression Scale. The results showed that ASD-group significantly lower levels of parenting self-efficacy and worse emotion than TD-group (p < 0.05); And after attending the program, ASD-group had significant improvements for all outcome measures and these changes maintained over a period of time (p < 0.05). This preliminary study suggests that the FFPT may effectively improve parenting self-efficacy, reduce anxiety and depression for parents of children with ASD.

Strengthening Clinical Research in Marriage and Family Therapy: Challenges and Multilevel Solutions

There is a critical need for high-quality and accessible treatments to improve mental health. Yet, there are indications that the research being conducted by contemporary marriage and family therapy (MFT) scholars focuses less on advancing and disseminating clinical interventions than in previous decades. In this article, we describe challenges to increasing rigorous clinical research in MFT. We use systems mapping and the intervention-level framework to identify strategic goals designed to drive innovation in clinical research in the field. It is our hope this article encourages dialog and action among MFT stakeholder groups to support clinical science that will improve the health and functioning of families.

Clinical and Supervisory Considerations for Transgender Therapists: Implications for Working with Clients

Transgender therapists have unique and valuable perspectives into how gender organizes the therapeutic process. Currently, in the MFT field, there is discussion of the cisgender therapist's experience in the therapy room, but no known articles on the transgender therapist's experience. This article provides insight into the experiences of transgender therapists around issues of self-disclosure, social locations of both therapist and client, and clinical supervision. Drawing from our clinical experiences as transmen, we highlight special considerations for working with cisgender, queer, and transgender clients. Implications for supervision of transgender therapists are also discussed. As more gender diverse students seek MFT training, there is an urgent need to acknowledge their perspectives. This article is a call for beginning conversations in this direction.

Dyadic Supervision Evaluation: An Actor-Partner Relational Model

This article contributes to research practices in marital and family therapy, specifically the dyadic and development over time in clinical supervision, and describes and applies methodological strategies to develop measurements congruent with the systemic and developmental principles of the field. This project evaluates the psychometric properties of the dyadic supervision evaluation (DSE) in terms of measurement equivalence and causality. A structural equation analysis is conducted utilizing the actor-partner interdependent model resulting in a goodness of fit. This study presents a longitudinal model for evaluating the supervisory relationship and proposes a model of clinical supervision evaluation. The relationship among latent constructs in the DSE and its limitations related to inference and application are discussed.

Moving Between Dialogic Reflexive Processes In Systemic Family Therapy Training: An Interpretative Phenomenological Study of Trainees' Experience

In this article, we present a qualitative research study concerning the ways that systemic family therapy trainees experience reflexivity while in training. There is inadequate theorizing and limited research concerning reflexivity in family therapy, particularly from trainees' perspective. In our study, we used Interpretative Phenomenological Analysis to analyse transcripts of semistructured interviews with 10 systemic family therapy trainees. Here, we present one of the four superordinate analytic themes, entitled "Moving between reflexive processes". Our analysis suggests that trainees seem to experience reflexivity as a multifaceted, dialogic process, which occurs both at an inner and at an outer space and both synchronically but also subsequently to the therapeutic/training process. We conclude by raising implications for family therapy training. Video abstract accessible by clicking here.

A Contextual Therapy Framework for MFT Educators: Facilitating Trustworthy Asymmetrical Training Relationships

This article provides a conceptual framework for asymmetrical relationships between family therapy educators and trainees. Our framework is based on contextual family therapy, and we apply the concepts of trust, entitlement, self-validation, and loyalty to training relationships. We highlight the value of educators modeling responsible uses of power in addition to teaching trainees clinical concepts and skills. We propose that training can be a process where trainers earn constructive entitlement through their interactions with trainees, who then give to future clients, supervisees, and trainees to continue the cycle of intergenerational trustworthiness. We also provide examples that illustrate the application of contextual therapy skills such as multidirected partiality, I-Thou relating, acknowledgment, validation, and accountability to family therapy training.

Common Factors' Role in Accredited MFT Training Programs

Common factors proponents discuss the benefits and methods of including common factors in marriage and family therapy (MFT) training; yet there are no empirical investigations of how common factors are incorporated into MFT curricula. The purpose of this study was to obtain a baseline understanding of common factors' role in MFT training. Thirty-one directors of COAMFTE- and CACREP-accredited MFT training programs responded to a survey about the inclusion of common factors in their training program, as well as the benefits, challenges, and students' reactions to common factors training. Findings show that common factors are regularly included in MFT training programs and have garnered largely positive responses. Additional results are discussed regarding the implications of common factors in MFT training.

Human Sexuality Education in Marriage and Family Therapy Graduate Programs

Given the likelihood that marriage and family therapists will encounter clients with sexual concerns, it is important to know how graduate training programs are preparing future clinicians to work with this domain of life. Sixty-nine marriage and family therapy (MFT) program directors completed an online survey to examine how sexual health education is integrated into graduate training programs. Findings indicate that while the majority of program directors value sexuality curriculum, and most programs require at least one course in this area, there are barriers to privileging sex topics in MFT graduate programs. Barriers include few MFT faculties with expertise in human sexuality and marginalized sexual health topics. Implications for training MFT graduate students and their work with future clients are discussed.

Does the Person-of-the-Therapist Training (POTT) Promote Self-Care? Personal Gains of MFT Trainees Following POTT: A Retrospective Thematic Analysis

As we recognize how taxing our profession can be, therapist's self-care has become a salient topic in mental health. However, we are still discerning how to promote self-care in our practice and in training. In this paper, we present a study on the personal gains that MFT students experienced after participating in the Person-of-the-Therapist Training (POTT). We propose that the reported changes (better understanding of self, change to self, relational changes, and change as a process) constitute improvements in the trainees' well-being, and can therefore be considered self-caring behaviors and practices. We state that models like POTT, that focus on embracing our vulnerability, can help clinicians be more caring toward ourselves. We conclude this paper by presenting clinical and training recommendations.

Addressing the Person of the Therapist in Supervision: The Therapist's Inner Conversation Method

In this study a method of retrospective case supervision is presented aimed at helping the supervisee to become a better self-supervisor. The method pays special attention to the therapist's self-reflection and has the therapist's inner conversation as a central concept. The starting point of the method is an assignment in which the supervisee reflects on a case using a tape-assisted recall procedure. The method helps trainees to develop experiential expertise to become more flexible and effective therapists. A case example of one training group of novice family therapists illustrates the use of the method.

Clinical Training and Practice Patterns of Medical Family Therapists: A National Survey

Medical family therapy (MedFT) has gained momentum as a framework in healthcare for individuals and families. However, little is known about what background training and clinical experiences Medical Family Therapists (MedFTs) have in everyday practice. This study investigated the clinical training of MedFTs and their practices in a variety of care settings. A survey was completed by 80 participants who use a MedFT framework in practice, with descriptive data on curriculum, clinical training, and treatment characteristics. Results reflect that many MedFTs lack formal coursework in key content areas of their graduate training and work primarily with psychological and relational concerns. Future research is needed to explore how MedFTs practice around specific mental health and chronic health conditions.

Are we there yet? Faculty Members' Beliefs and Teaching Practices Related to the Ethical Treatment of Lesbian, Gay, and Bisexual Clients

The purpose of this study was to explore (a) faculty members' beliefs about the ethics of reparative therapy and referring lesbian, gay, and bisexual (LGB) clients, (b) course content related to reparative therapy and referral of LGB clients, and (c) positions taken by programs associated with reparative therapy and referral of LGB clients. A total of 117 faculty members from accredited family therapy programs completed an online survey for this study. While the vast majority of faculty members reported that reparative therapy is unethical, there was less agreement related to the ethics of referring LGB clients, which may highlight the need for clearer ethical guidelines to regulate this potentially harmful practice. Implications for clinical training and future research are discussed.

Training for Connection: Students' Perceptions of the Effects of the Person-of-the-Therapist Training on Their Therapeutic Relationships

The Person-of-the-Therapist Training (POTT) is a program designed to facilitate clinicians' ability to consciously and purposefully use their selves to effectively connect, assess, and intervene with clients. This study explored CFT students' perceptions of the effects of POTT on their ability to create positive therapeutic relationships. Course papers and final reflections were collected from 70 CFT students. Directed content analysis looking for evidence-supported elements of positive therapeutic relationships revealed 5 elements: empathy, management of countertransference, balancing multiple alliances, positive regard, and bond. Findings support the idea that a structured program focused on the training of the personal aspects of the therapists, like POTT, can promote the evidence-supported elements that make a therapeutic relationship effective.

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.

The State of Lesbian, Gay, and Bisexual Affirmative Training: A Survey of Faculty from Accredited Couple and Family Therapy Programs

This study explored the state of lesbian, gay, and bisexual (LGB) affirmative training in the couple and family therapy field. LGB affirmative refers to holding positive views of LGB identities and relationships. A total of 117 faculty members completed the online survey for this study. Participants were asked to respond to items on the following topics: LGB affirmative stances, LGB affirmative program environment, LGB affirmative course content, self-of-the-therapist work, and professional opportunities to work with LGB topics and clients. The findings of this study were encouraging as participants reported holding positive beliefs about LGB individuals, that their training programs had fairly affirmative program environments, and that LGB affirmative course content was included in their program curriculum.

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.

Perceived professional gains of master's level students following a person-of-the-therapist training program: a retrospective content analysis

The Person-of-the-Therapist Training (POTT) is a program designed to facilitate clinicians' ability to consciously and purposefully use themselves at the moment of contact with their clients in order to connect, assess, and intervene effectively. This qualitative study explored the experiences of 54 master's-level students who were enrolled in an accredited marriage and family therapy program in the United States and examined their perceived professional gains following a 9-month POTT course. Content analysis of trainees' reflections which they wrote at the end of the training revealed 6 primary themes: (a) increased awareness, (b) emotions, (c) improved clinical work, (d) humanity and woundedness, (e) meta-awareness, and (f) factors that contributed to the learning process. Findings suggest that key outcomes of this training curriculum are congruent with its stated goals. Clinical and training recommendations are additionally provided. Video Abstract.

Participant supervision: supervisor and supervisee experiences of cotherapy

Participant supervision is a unique application of live supervision in which a supervisor and supervisee see clients conjointly. Although minimally discussed in the family therapy literature, it has notable advantages, chief among them being a shared clinical experience that increases attunement to supervisee skill and development, the modeling of skillful intervention, and a higher degree of collegiality. However, it is not without its challenges, including supervisee vulnerability and anxiety, diffusion of responsibility, and limited time for case discussion. This article highlights the experience of one supervisor and three doctoral-level supervisees engaging in participant supervision over the course of a 2-year period. Using illustrative examples, we discuss our experience of the advantages and challenges of participant supervision, and provide recommendations for establishing a collaborative relational context within which supervisory benefits can be maximized.

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.

Vulnerable families as active agents of their own change process: a bidirectional perspective

The literature on successful practice with vulnerable families reports social workers' efforts in forging therapeutic bonds with clients, their ability to both recognize clients' strengths and pain and support them as they work through adversity. Vulnerable families' own contribu- tions to their change process, however, have remained largely opaque. This article offers concrete conceptual tools to consider both social workers and clients from vulnerable families as active agents in the change process. Empirical evidence collected by practitioner-researchers through in-depth discussions with 10 vulnerable families illustrates clients' agentic capacities for autonomy, construction, and action as well as joint construction and maintenance of the helping relationships with social workers, thereby illustrating their active contribution to the process of change.

Assessing lesbian, gay, and bisexual affirmative training in couple and family therapy: establishing the validity of the Faculty Version of the Affirmative Training Inventory

This study established the validity and factor structure of the Faculty Version of the Affirmative Training Inventory (ATI-F), which assesses faculty members' perceptions of the level of lesbian, gay, and bisexual (LGB) affirmative training that occurs in clinical programs. Additionally, this study examined the latent associations among the subscales of the ATI-F and three convergent validity items utilizing a sample of 117 faculty members from accredited family therapy programs. The findings provide empirical support for the relationship between including classroom content on LGB affirmative therapy and faculty members' beliefs about LGB individuals and relationships. Specifically, faculty members who report more positive beliefs about LGB clients appear to be more likely to include LGB affirmative therapy content in the courses they teach.

Using the tenets of the problem-centered systems therapy of the family (PCSTF) to teach the McMaster Approach to family therapists

This article describes the videoconferencing training of a group of family therapists in the McMaster Approach to evaluating and treating families. A discussion of the key tenets of the McMaster Approach lays the groundwork for how these tenets were applied to training in a residential treatment agency for adolescents. The article serves as an example of how videoconference technology can facilitate extended training, even from a distance.

Thinking and working relationally: interviewing and constructing hypotheses to create compassionate understanding

In the initial interviews of family therapy sessions, the therapist faces the challenge of obtaining and organizing the information that is most relevant toward understanding the essential concerns that families and couples bring to therapy. This article describes the process of clinical interviewing and case conceptualization used in training family therapists at the Ackerman Institute for the Family. This approach helps the therapist bring forward, and organize, specific information into relational hypotheses, or systemic-relational conceptualizations, that allow both family members and the therapist to understand presenting problems within their relational contexts. While always provisional, relational hypotheses help anchor the therapist in a systemic-relational frame and provide a conceptual through-line to guide the ongoing work of the therapy. The process of interviewing and the construction of clear and complex conceptualizations of presenting problems are illustrated through case examples.

Putting the "family" back into family therapy

In this article, we examine the field of family therapy by drawing a distinction between two forms of practice: Whole Family Therapy (WFT), defined as treating the whole family, and Relational Family Therapy (RFT), defined as working with a subsystem of the family or an individual while retaining a systemic lens. Our thesis is that the practice of WFT has been in decline for some time and steps must be taken to keep it from becoming a defunct practice. We consider the trajectory of WFT and RFT throughout the development of family therapy through reference to the people, the literature, training, and practice patterns associated with family therapy. We remind the reader of the many benefits of WFT and suggest that today WFT is likely to be practiced in conjunction with RFT and individual therapy. Since training of family therapists today is largely located in degree-granting programs, we identify constraints to including WFT in such programs. We conclude by offering suggestions that can enhance a program's ability to train students in WFT.

Being a family systems thinker: a psychiatrist's personal odyssey

This account traces the development of family systems thinking from early pioneering thinking and practices, through the development of institutions and professional definitions, and through challenges to family systems thinking and practice from the biomedical points of view. Throughout there is a strong conviction that "thinking family" is an essential core of effective mental health treatment, because families can heal.

The role of family institutes in promoting the practice of family therapy

Much of the development of family therapy as a discipline was an outcome of the clinical, training, and theory-building activities conducted at family institutes around the United States. Beginning in the 1960s, these institutes were the crucibles in which the concepts and practices of family therapy flourished. The author, a leader at one of the largest family institutes in the United States, discusses the role of family institutes in promoting the practice of family therapy, as well as the challenges of doing so.

Eschewing certainties: the creation of family therapists in the 21st century

I reflect here on Family Therapy's origins, our present dilemmas, and future possibilities. Using the lens of training new Family Therapists for current public sector domains, I examine our field's strengths, vulnerabilities, and contradictions. I critique the current vogue of model certainty and branding. Our responsibilities to trainees, young practitioners, and the families we serve are highlighted.

Getting comfortable as "fish out of water": using qualitative research methods training to enhance the technical capacity of family therapy trainees

This article describes a qualitative research methods training project undertaken in a COAMFTE-accredited family therapy master's-level program. Graduate students were trained to collect research data for a qualitative study on the resilience of families displaced to the United States because of war and politically motivated violence in their country of origin. By involving trainees in a research project with refugees, the project was intended to address a gap in clinicians' training, specific to the refugee population (Miller, Muzurovic, Worthington, Tipping, and Goldman, American Journal of Orthopsychiatry 2002; 72: 341). However, the training process was also a way to increase the students' skills at interviewing in complex situations, develop their cultural sensitivity beyond awareness, enhance their capacity for routine self-reflection, and introduce them to basic practices of qualitative research methodology. In this article, we focus on the students' experience of the training and discuss the potential implications of their feedback for family therapy training.

Critical patriotism: incorporating nationality into MFT education and training

Topics such as national identity, patriotism, nationalism, and international issues often lead to polarization within the United States and as a result, critical dialogue about these complex topics often does not occur in a meaningful way. The lack of critical inquiry and interaction about these topics is manifest at the macro and the micro level, including within the context of marriage and family therapy training and practice. While the field of MFT has devoted greater attention to addressing issues of diversity in recent years, limited attention has been focused on examining nationality and nationalism. This article presents a critical patriotism framework that training programs can use to examine nationality and expand awareness of international issues and perspectives. Special attention is focused on examining how nationalism, a problematic extreme version of patriotism, infiltrates MFT training and practice. Recommendations are provided for how training programs can focus on nationality, expand awareness of international issues and perspectives, and guide trainees in exploring how their national identity, beliefs about patriotism, and nationalistic attitudes may influence their clinical work.

Core competencies in social constructionist supervision?

Family therapy is moving increasingly toward evidence-based practice and competency-based training. This article explores what might seem to be an unlikely link between social constructionist supervision, which is based on dialogic and fluid processes of meaning-making, and the increasing reliance on discrete core competencies in the education and training of family therapists. We propose an alternate approach to competencies for supervision with therapists in training that, among other things, invites accountability and provides evaluative props. The approach we propose is based on a set of orientations that we hope reflect the dialogic and contextual nature of social constructionist practice and supervision. These orientations consist of reflexivity and attention to power, fostering polyphony and generativity, collaborative stance, and focus on client resourcefulness. Ideas and questions for supervisors and therapists in training to address the orientations are articulated.

Social class in family therapy education: experiences of low SES students

In this article, we report the results of a national survey of students in COAMFTE-accredited family therapy programs who self-identify as coming from lower- or working-class backgrounds. Results of the study reveal opportunity and tension relative to family, friends, and community because of social mobility associated with graduate education. Participants describe family therapy education as middle-class centered, pointing to lack of attention to social class, marginalization, classism, and unacknowledged class barriers as salient experiences in their graduate programs. Finally, participants share a number of suggestions for program improvement.