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The connection between adverse childhood experiences (ACEs) and anxiety disorders is well-documented. Additionally, therapy has been shown to be effective at reducing anxiety symptoms. Yet more needs to be known about how ACEs may shape the process of therapy and the trajectory of anxiety symptoms. This study was designed to compare the trajectory of improvement in anxiety symptoms over the course of 12 sessions of therapy in adults (N = 472), who reported more (greater than four) and fewer (fewer than four) ACEs using a multigroup latent growth curve analysis. Data were drawn from the Marriage and Family Therapy Practice Research Network database. Results suggested that the rate of improvement in those with more and fewer ACEs was not significantly different; however, those with more ACEs had a significantly higher average starting point of anxiety symptoms., (© 2024 American Association for Marriage and Family Therapy.)

A paradigmatic shift toward postmodern, collaborative practice in family therapy raises questions about how therapists can use professional authority to facilitate change and how clients can assert their knowledge and agency. We used conversation analysis to investigate how the authority to know and to determine here-and-now action (i.e., who does what, and how, in therapy) was negotiated and accomplished in 10 sessions of emotion-focused therapy involving chair work. Therapists were observed to rely on a particular interactional sequence structure: stepwise entry into a directive, in which directives were preceded by a question-answer sequence. We show how instances where clients' views were elicited prior to the delivery of a directive resulted in different interactional consequences from instances where therapists straightforwardly directed clients to perform some action. The study offers evidence concerning how therapists can facilitate chair work collaboratively and responsively., (© 2021 American Association for Marriage and Family Therapy.)

Emotion-focused family therapy (EFFT) is a therapy model which includes a two-chair intervention aimed at facilitating awareness and an interruption of problematic patterns of parenting as well as a reconnection to healthy caregiving instincts. The present study employed a task analysis to examine the process of this intervention with parents in a therapeutic setting and report on preliminary outcomes. Four trained EFFT therapists conducted chair work interventions with four parents (total of 16) and parents completed questionnaires directly following the intervention. Results indicated that most parents experienced significant emotional resolution of their love-based fears and an increase in confidence in supporting their children struggling with mental health issues. Use of the intervention in clinical settings is an effective and efficient way to support parents in responding to their children's mental health challenges., (© 2021 American Association for Marriage and Family Therapy.)

Among U. S. Limited English Proficiency (LEP) communities, language needs and preferences create significant barriers to accessing quality healthcare and contribute to growing physical and mental health disparities. To mitigate these barriers, it is critical to recruit and train a new generation of linguistically diverse providers, including marriage and family therapists (MFTs). This study examined how Marriage and Family Therapy (MFT) program website content promotes a commitment to recruiting and training multilingual MFTs. The study sample consisted of all currently accredited programs (N = 122) and included coding for the presence or absence of (a) an explicit commitment to multiculturally and linguistically informed training, (b) specialized multilingual training and supports, and (c) multilingual faculty involved in training multilingual students or engaged in related scholarship. Results indicate that a majority of MFT programs are communicating a commitment to multiculturally informed training, but the same is not true of linguistically responsive training., (© 2021 American Association for Marriage and Family Therapy.)

Applying Dialogical Methods for Investigations of Happening of Change (DIHC), this study investigated how children who had been diagnosed with an oppositional defiant or conduct disorder participated in a collaborative post-therapy research interview and talked about their experiences of family therapy. The results showed that the children participated as dialogical partners talking in genuine, emotional, and reflective ways. Encountered as full-membership partners, the children also co-constructed meanings for their sensitive experiences. However, their verbal initiatives and responses appeared in very brief moments and could easily have been missed. The collaborative post-therapy interview offered a safe forum for co-reflection by participants on what they had found useful or difficult in the family therapy process. In this interview setting, the family first listens to reflection by the therapists on the therapy process and their thoughts on some of the family's related sensitive issues. The results indicate that when therapists present themselves as not-knowing, receptive and accountable, therapists may facilitate reflection for all family members, including children., (© 2021 The Authors. Journal of Marital and Family Therapy published by Wiley Periodicals LLC on behalf of American Association for Marriage and Family Therapy.)

The COVID-19 pandemic has transformed so many aspects of our lives. For psychotherapists, telehealth is likely a permanent part of the future mental health landscape. For family therapists using a manualized treatment, this brings unique challenges and creative opportunities. In this article, we describe the adaptation of attachment-based family therapy (ABFT) in the context of telehealth and COVID-19. ABFT is an empirically supported treatment model designed for adolescents and young adults struggling with depression, anxiety, trauma, and suicide. ABFT is a semi-structured, process-oriented, and trauma-informed family therapy model which presents its own unique challenges and benefits in telehealth environments. We present our adaptations based on years of telehealth clinical experience and address how this model supports the impact of COVID-19 on families., (© 2021 American Association for Marriage and Family Therapy.)

The novel Coronavirus pandemic (COVID-19) and subsequent social distancing practices have altered the way we move through the world and access physical and mental healthcare. While researchers and clinicians have begun to explore the impact of telehealth delivery on psychotherapy and treatment outcomes, the purpose of this study was to explore the lived experiences of individuals in teletherapy, specifically those engaging in teletherapy with a romantic partner or family member. Using a thematic analysis of open-ended online survey questions, we explored the experiences of 25 individuals who engaged in couple or family teletherapy after social distancing began. The resulting themes included "making do," safe therapeutic space, convenience, logistical challenges, and therapist accommodation. We discuss the clinical implications of these themes to support effective couple and family teletherapy and offer suggestions and considerations for remote clinical interventions and practices. [Correction added on 22 March 2021, after first online publication: The term '19' has been changed to '(COVID-19)' in the first line of the Abstract section, in this version.]., (© 2021 American Association for Marriage and Family Therapy.)

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., (© 2020 American Association for Marriage and Family Therapy.)

This study explored the change that unfolded when parents resolved their coparenting dissatisfaction during an Integrative Brief Systemic Intervention (IBSI) for parent couples. We conducted a task analysis (Greenberg, 2007) to build a model of resolving coparenting dissatisfaction. We compared a postulated model of change (rational model) based on theoretical and clinical assumptions to the observations of the actual change process that couples experienced in an IBSI (empirical analysis). The empirical analysis was conducted on six IBSI therapy cases (three exhibiting positive development and three exhibiting no development). We defined positive development in IBSI as moving from coparenting dissatisfaction to coparenting satisfaction. The final rational-empirical model included six steps that facilitated the resolution of coparenting dissatisfaction. This study contributes to deepening the knowledge of how coparenting may change during marital therapy., (© 2020 American Association for Marriage and Family Therapy.)

Open Dialogue is a collaborative systemic approach to working with families in crisis. A core feature is the creation of dialogue through the elicitation of a multiplicity of voices. Using conversation analysis, we studied 14 hr of Open Dialogue sessions. We found that therapists recurrently produced utterances containing "I'm wondering." These utterances topicalized particular issues and invited stance positions from other participants while also allowing the therapist to mitigate their deontic authority and present potentially disaligning stances. Therapists thus exercised authority in eliciting stances, but provided recipients with multiple avenues for responding. These findings illustrate that therapist authority is not necessarily antithetical to dialogue and, in well-crafted forms, may even be necessary for the creation of polyphony through the elicitation of multiple stances., (© 2020 American Association for Marriage and Family Therapy.)

Youth behavior problems have increased in prevalence in Scandinavian countries. Functional Family Therapy (FFT) has been shown to be an effective intervention across diverse populations and international contexts. The current study examines the effectiveness of FFT within a Danish-community sample in a pre-post comparison design and includes 687 families. Observed outcomes included both parent- and/or youth- reported domains of youth behavior, family dysfunction, school attendance and performance, and substance use. Significant improvements were found in youth behavior, family functioning, and school-related outcomes (e.g., like of school and truancy) despite experiencing a 60% attrition rate in our sample postintervention. This study provides evidence for the effectiveness of FFT on a wide scale in a Scandinavian context, adding to previous research that supports the transportability of this intervention., (© 2019 American Association for Marriage and Family Therapy.)

As routine outcome monitoring systems develop, questions emerge about how therapists incorporate feedback into their practice, and how this relates to therapeutic gains. A case of covert grief was monitored in each session with the Personal Questionnaire and the Helpful Aspects of Therapy instruments. At 4 months follow-up, the Change Interview was administered. Individualized items facilitated access to the private views and needs of each member, which was useful for case formulation and ongoing personalization of the intervention. Qualitative feedback of treatment experiences helped therapists confirm the impacts of interventions, monitor therapeutic alliance, reformulate clinical hypothesis, and plan sessions. Therapists followed a critical triangulation process to decide the clinical meaning of feedback, according to his/her intervention model, expertise, and case-specific context., (© 2018 American Association for Marriage and Family Therapy.)

Family functioning is predictive of youth recidivism in Singapore. However, there is a lack of family based interventions for youth offenders on community probation. Evidence-based family interventions developed in Western populations, such as Functional Family Therapy (FFT), have been found to be effective in mitigating subsequent youth criminal behavior. However, no study has examined whether such interventions can be implemented and adapted for use in Eastern cultures. Thus, this paper sought to detail the implementation of FFT in Singapore. Rationale for the adoption of FFT is discussed, and key activities undertaken during the first 18 months of implementation are described. Preliminary data suggest that initial implementation efforts were successful. Challenges encountered, and implications in relation to the broader literature are discussed., (© 2018 The Authors. Journal of Marital and Family Therapy published by Wiley Periodicals, Inc. on behalf of American Association for Marriage and Family Therapy.)

This study evaluated the 2-day intensive modality of Emotion Focused Family Therapy (EFFT). The intervention attempts to prepare parents to take a primary role in their child's recovery from a range of mental health issues. One hundred and twenty-four parents completed the intervention and provided data a week prior to intervention, post-intervention and at 4-month follow-up. Results include significantly reduced parent blocks and increased parental self-efficacy in relation to involvement in their child's recovery, as well as significant improvement in child symptomatology. The findings confirm positive results from an earlier pilot study involving eating disorders and demonstrate the potential for EFFT as an intervention for a range of clinical problems in children and youth., (© 2018 American Association for Marriage and Family Therapy.)

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., (© 2018 American Association for Marriage and Family Therapy.)

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., (© 2018 American Association for Marriage and Family Therapy.)

Studies have generally supported telehealth as a feasible, effective, and safe alternative to in-office visits. Telehealth may also be of particular benefit to couples/families interested in relational treatments, as it addresses some of the barriers that may be more prominent for families, such as childcare and scheduling difficulties. Therapists interested in expanding their practice to include telehealth should understand ethical and practical considerations of this modality. This article discusses areas unique to the delivery of telehealth to couples and families. Each broad domain is then elaborated upon with case examples from actual clinical practice and specific recommendations for addressing potential difficulties. Authors recommend further empirical research examining differences in modality outcome, as well as feasibility of the suggestions proposed here., (© 2018 American Association for Marriage and Family Therapy.)

The field of Couple, Marital, and Family Therapy (CMFT) has evolved and strengthened, but we still have work to do when it comes to identity, comprehensive scholarly resources, empirical support, and name brand recognition. We explore the reasons for these challenges and propose ways to address them: embracing the interdisciplinary nature of the field, consistently organizing treatment effectiveness by problem rather than by intervention model, continuing innovation in theory development, and utilizing more diverse and meaningful research methods. This approach provides a more accurate representation of the scope of practice of CMFTs, the range of mental and physical health problems we address, and the depth and extent of the existing research on the effectiveness of relational therapies., (© 2017 American Association for Marriage and Family Therapy.)

Family therapists know that clinical concerns are not separate from larger sociopolitical contexts. Attunement to clients' sociocultural experience is foundational to good practice, yet few guidelines integrate attention to the larger societal processes or address social equity. The purpose of this article is to help therapists move from knowing about sociocontextual issues to doing socioculturally attuned practice. We offer an overarching framework that returns to Bateson and the roots of family therapy through a call for third order transformation. The approach is responsive to societal context and an analysis of power while working through enduring concepts of major family therapy models. Transtheoretical guidelines that can be integrated across practice models to promote third order change are illustrated with case examples., (© 2017 American Association for Marriage and Family Therapy.)

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., (© 2018 American Association for Marriage and Family Therapy.)

Children of substance abusing parents are at heightened risk to develop problem behaviors, yet little is known about the co-occurring patterns of internalizing and externalizing behaviors among this population. With 183 children (M age = 11.54 years, SD = 2.55, range 8-16) whose mothers were diagnosed with a substance use disorder, the current study identified subgroups/classes of children that were clinically distinct in their co-occurring patterns of internalizing and externalizing behaviors, and examined how children in different clinical subgroups responded to a family systems intervention. Latent class analyses identified four classes of internalizing and externalizing behaviors: internalizing only, externalizing only, comorbid, and normative. Latent transition analyses showed that participation in family systems therapy resulted in an increased likelihood of transitioning from the externalizing class at baseline to the normative class at 18 months post-baseline, and from the comorbid class at baseline to the internalizing class at 18 months post-baseline as well. The findings support the effectiveness of family systems therapy in interrupting the stability of children's problem behaviors and improving children's behavioral outcomes., (© 2017 American Association for Marriage and Family Therapy.)

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., (© 2017 American Association for Marriage and Family Therapy.)

Ivan Boszormenyi Nagy introduced with his contextual therapy a challenging theory into the world of family therapy. It is rooted in a relational ethical perspective on human relations and shifts the focus of therapy from pathology to evoking reciprocal care and a genuine dialogue, based on the conviction that inter-human relations are resources for individual growth and health. This article presents a research project on the practice of the founder himself, to describe how the principles of the contextual theory and therapy can be integrated into concrete therapeutic interventions. Using the Constant Comparison Method, the authors found six clusters of interventions representing methodical elements through which Ivan Boszormenyi-Nagy applies the paradigm of his approach., (© 2017 American Association for Marriage and Family Therapy.)

In this article, we aim to introduce the special JMFT section on discursive research methodologies for couple and family therapy research. These are qualitative research methodologies which resonate with the systemic emphasis on the semantics and the pragmatics of therapy discourse. First, we provide a brief overview of such methodologies and their use in the family therapy field. We then introduce the context and the content of the special section, where four approaches, including conversation analysis, discursive psychology type of discourse analysis, poststructurally informed discourse analysis (subject positioning analysis), and semantic analysis, are introduced by means of analyzed extracts from a Tom Andersen consultation session with a couple in distress and their therapist. We conclude with implications for the field. For Tom and Michael., (© 2018 American Association for Marriage and Family Therapy.)

Tom Andersen and his pioneering work with reflecting conservations has had a lasting influence on the field of family therapy and mental health more broadly. Most family therapists are familiar with his contributions related to reflecting teams; however, fewer are familiar with his conceptualization of reflecting processes, which offer practical ways to approach therapeutic conversations to address challenging problems. This article provides a brief history of Andersen's career and reviews four key elements of his approach, including: (a) his way of being in relationship, (b) appropriately unusual comments, (c) inner and outer dialogs, and (d) ethics of dialogical relating. Finally, this article introduces readers to the context of the video that will be analyzed in the articles that follow in this special section., (© 2018 American Association for Marriage and Family Therapy.)

The field of couple and family therapy has benefitted from evidence generated from qualitative approaches. Evidence developed from approaches relying on language and social interaction using naturally occurring recordings of real-world practice has the benefit of facilitating practice-based recommendations and informing practice. The aim of this article is to provide an overview of one approach to discourse analysis, Discursive Psychology (DP), demonstrating how a social constructionist framework and focus on discourse can provide an important contribution to the field of therapy. To illustrate the methodological decision-making process for researchers and/or practitioners who utilize DP, we draw upon a video-recorded therapeutic session involving Tom Andersen. To conclude, we make recommendations for practitioners using DP to explore and examine therapeutic practice., (© 2018 American Association for Marriage and Family Therapy.)

Parents and children exposed to war and relocation have high rates of negative relational and mental health outcomes. This study tested the feasibility of implementing an adapted evidence-based parenting intervention for contexts of trauma and relocation stress. Eleven Karen refugee caregivers from Burma participated in the intervention. Participants and a focal child completed ethnographic interviews as well as structured assessments at baseline and follow-up. Caregivers reported changes in their teaching, directions, emotional regulation, discipline, and child compliance. Children reported changes in these areas and in positive parent involvement. Caregivers reported higher mental health distress immediately after the intervention, potentially due to increased awareness. Researchers made personalized referrals for counseling services as needed. Children reported a decrease in mental health symptoms., (© 2017 American Association for Marriage and Family Therapy.)

The purpose of this article is to review the scientific evidence on the effects of family based interventions for suicidal ideation and behavior. We conducted an extensive search of electronic databases using a comprehensive search strategy. This search resulted in 16 studies that tested 13 interventions for treating suicidal ideation and behavior using family based interventions. Of the interventions identified, three yielded an overall improvement in suicidal ideation and behavior while an additional three interventions produced partial improvement in mental health symptoms. These studies targeted suicidal ideation and behavior in youth or adolescents while no studies examined family interventions for adults with suicidal ideation and behavior. The limitations of these studies and the need for additional research are examined., (© 2017 American Association for Marriage and Family Therapy.)

Marriage and family therapists (MFTs) use ethical codes and state licensure laws/rules as guidelines for best clinical practice. It is important that professional codes reflect the potential exponential use of technology in therapy. However, current standards regarding technology use lack clarity. To explore this gap, a summative content analysis was conducted on state licensure laws/rules and professional ethical codes to find themes and subthemes among the many aspects of therapy in which technology can be utilized. Findings from the content analysis indicated that while there have been efforts by both state and professional organizations to incorporate guidance for technology use in therapy, a clear and comprehensive "roadmap" is still missing. Future scholarship is needed that develops clearer guidelines for therapists., (© 2017 American Association for Marriage and Family Therapy.)

While Functional Family Therapy (FFT) is known to be effective in addressing adolescent behavioral problems, there has been little exploration of issues relevant to its transport from the tightly controlled setting of clinical trials into routine service delivery. This study sought the views of key stakeholders, clients, and practitioners, on barriers and facilitators to the successful implementation of FFT. Undertaken in a community setting in Scotland, interviews were carried out with 12 adolescents, 14 parents/caregivers, and 6 practitioners. Results focus on: Referral process and pre-intervention contact; Engagement of families; Structure and delivery; Organizational factors. Although barriers to engagement were identified, FFT was viewed as an acceptable, appropriate and feasible intervention with the potential to improve adolescent wellbeing in 'real-world' settings., (© 2017 American Association for Marriage and Family Therapy.)

Online forums and lay literature suggest that partners of individuals with Autism Spectrum Disorder (ASD) experience depression, distress, and trauma in their everyday lives, exacerbated during the time surrounding diagnosis. In this content analysis, 29 participants were provided with an online open-ended statement asking them to describe in writing their experiences of discovering that their partners had ASD during their relationships. Six themes emerged, including: facing unique challenges within relationships; insisting partners seek diagnosis; initial shock and relief; losing hope for normalcy; making accommodations within relationships; and wishing for professional support. Marriage and family therapists should help couples minimize blaming and promote self-awareness, appropriate relationship expectations, and mutual understanding. Future research should explore the overall experience of neuro-mixed relationships for both partners., (© 2017 American Association for Marriage and Family Therapy.)

Many families come to therapy struggling with the negative consequence of social inequity. Family therapy modalities have been developed to address these negative consequences and attend to power and social equity (Transformative family therapy: Just families in a just society. Boston, MA: Pearson Education; Socio-emotional relationship therapy. New York, NY: Springer). We argue that many family therapy modalities can be adapted to include social equity (Applying critical social theory in family therapy practice. AFTA Springer Series. New York, NY: Springer Publishing). Specifically, cognitive behavioral family therapy can be used to address the inequality in social systems that negatively affect the family system. We focus on schema formation and suggest an emphasis on societal schemas within the therapy milieu as a tool to help families see how societal inequality can affect the problems faced in family life., (© 2016 American Association for Marriage and Family Therapy.)

Relational family therapy (RFT) is a psycho-organic therapeutic approach that combines intrapsychic dynamics with interpersonal mechanisms and a systemic perspective. This integrative model is based on the assumption that the repetitive patterns of relationships in early childhood repeat in adulthood. It often happens that a sexually abused individual will later unconsciously be attracted to someone with whom they will relive the abusive atmosphere and dynamics from childhood. The purpose of this contribution is to present the RFT approach for dealing with sexual abuse. We will present a case study with individual segments from therapy with a woman, who previously had been sexually abused and was separated from her partner., (© 2017 American Association for Marriage and Family Therapy.)

In this study, we evaluate the efficacy of multi-family therapy at reducing the addiction severity and at improving the psychological and family dynamics of opiate addicts receiving methadone treatment at a public treatment center. The study compares multi-family therapy with a reflecting team (MFT-RT) and a standard treatment following a methadone maintenance treatment program. The results show that multi-family therapy with a reflecting team effectively reduces the addiction severity in several of the areas evaluated and noted that this effect is superior to standard treatment. The psychotherapy patients showed improvement in the areas of employment and social support; their drug use diminished and their psychiatric condition improved. At the same time, they needed a lower daily dose of methadone. In addition, the group undergoing standard treatment showed a noteworthy deterioration in their medical condition. Both groups showed a significant increase in their alcohol use. When applied to family treatments, the systemic-constructivist approach by the reflecting team offers combined techniques that can help improve care for the families of patients with addiction problems., (© 2016 American Association for Marriage and Family Therapy.)

The first aim of this systematic review was to evaluate the evidence for family psychoeducation (FPE) interventions for major depressive disorder (MDD). A second aim was to compare the efficacy of different modes of delivering face-to-face FPE interventions. Ten studies (based on nine distinct samples) were identified comprising four single-family studies, four multifamily studies, one single versus multifamily comparative study, and one peer-led, mixed-diagnosis study. Seven studies measured patient functioning and six reported positive outcomes. Six studies measured carer's well-being and four reported positive outcomes. Results provide preliminary evidence that FPE leads to improved outcomes for patient functioning and family-carer's well-being for persons with depression. The implications for future development and delivery of FPE interventions for MDD are discussed., (© 2016 American Association for Marriage and Family Therapy.)

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., (© 2016 American Association for Marriage and Family Therapy.)

Emotionally focused family therapy (EFFT) is an attachment-based therapy model that has been used with older children and adolescents. More recently, it has been suggested for use with young children. EFFT holds promise as a clinical treatment for young children coping with attachment problems, but more detailed guidelines are needed for implementing the model with this age-group. Whereas preschool and kindergarten age children are less able to participate in talk therapy than older children, accommodations need to be made to this approach when the identified patient is a young child. This article offers a variety of play therapy activities that may be incorporated within an EFFT framework to strengthen the emotional bonds in families with children ages four to six., (© 2016 American Association for Marriage and Family Therapy.)

Eligible adolescents (12-17 years old) were recruited from a short-term crisis shelter for runaway adolescents in a large Midwestern city. Adolescents (N = 179) were randomly assigned to Ecologically-Based Family Therapy (EBFT, n = 61), the Community Reinforcement Approach (CRA, n = 57), or brief Motivational Enhancement Therapy (MET, n = 61) with the primary focus on substance abuse. A significant increase in perceived family cohesion and a significant reduction in perceived family conflict were found among all treatment conditions from baseline to the 24-month follow-up. Adolescents who received EBFT demonstrated more improvement in family cohesion after treatment than those who received CRA or MET, and more reduction in family conflict during treatment than those who received MET., (© 2015 American Association for Marriage and Family Therapy.)

This article describes the application of Attachment-Based Family Therapy (ABFT) to the treatment of a 13-year-old female adolescent presenting with high risk of suicide, complicated by a history of depression and sexual trauma. The article begins with an overview of ABFT, including (a) how attachment theory guides treatment; (b) the structure of the clinical model; and (c) the data that provide empirical support. A case example is then presented that exemplifies the primary clinical procedures used to reach therapeutic goals in ABFT, including attachment repair and autonomy/competence promotion. Weekly changes in suicide ideation and depression scores are presented. The article concludes with a discussion about implications for family-based treatment of suicidal youth., (© 2015 American Association for Marriage and Family Therapy.)

For over 20 years, family therapist Karl Tomm has been engaging families and couples with a therapeutic intervention he calls Internalized Other Interviewing (IOI). The IOI (cf. Emmerson-Whyte, 2010; Hurley, 2006) entails interviewing clients, from the personal experiences of partners and family members as an internalized other. The IOI is based on the idea that through dialogues over time, one can internalize a sense of one's conversational partner responsiveness in reliably anticipated ways. Anyone who has thought in a conversation with a family member or partner, "Oh there s/he goes again," or anticipates next words before they leave the other's mouth, has a sense of what we are calling an internalized other. For Tomm, the internalized anticipations partners and family members may have offers entry points into new dialogues with therapeutic potential-particularly, when their actual dialogues get stuck in dispreferred patterns., (© 2015 American Association for Marriage and Family Therapy.)

Medical family therapy (MedFT) is a growing area of interest within the field of marriage and family therapy. Its practice necessitates a shift from conventional family therapy practices to include diverse ways of providing care. Literature highlights approaches for patients with specific illnesses and for particular healthcare contexts. Less is understood about frameworks for treating patients with different illnesses across settings. Contributing to the growing discourse surrounding MedFT, we present a role-based practice framework that identifies six consistent roles, Therapist, Brief Interventionist, Health Coach, Patient Advocate, Consultant to Health Professionals, and Trainer specific tasks associated with each. We describe the skills needed to perform each role and describe how we move fluidly between roles to provide comprehensive care., (© 2014 American Association for Marriage and Family Therapy.)

We describe the development of an innovative program to support physician vitality. We provide the context and process of program delivery which includes a number of experimental support programs. We discuss a model for intervention and methods used to enhance physician resilience, support work-life balance, and change the culture to one that explicitly addresses the physician's biopsychosocial-spiritual needs. Recommendations are given for marriage and family therapists (MFTs) who wish to develop similar support programs for healthcare providers. Video Abstract., (© 2014 American Association for Marriage and Family Therapy.)

We explored how the therapeutic alliance contributed to retention in Brief Strategic Family Therapy by analyzing videotapes of eight-first sessions in which four therapists worked with one family that stayed in treatment and one family that dropped out. Although behavioral exchange patterns between clients and therapists did not differ by retention status, positive therapist alliance-related behavior followed negative client alliance behavior somewhat more frequently in the retained cases. In the qualitative aspect of the study, four family therapy experts each viewed two randomly assigned sessions and commented on their quality without knowing the families' retention status. A qualitative analysis of the audiotaped commentaries revealed 18 alliance-related themes that were more characteristic of either the retained or the nonretained cases., (© 2015 American Association for Marriage and Family Therapy.)

The purpose of this study was to explore the experiences and observations of marriage and family therapists (MFTs) conducting an empirically supported parenting program at a transitional homeless community. A diary method was used in recording five MFTs' observations and reactions to implementing the psychoeducational groups. Fifty-one recordings were collected from three different parenting groups over the course of 20 weeks. Constant comparative method was used to identify themes related to MFTs' experiences of conducting the parenting program. These themes included the needs of at-risk families, confidentiality, and role ambivalence and boundary ambiguity. We provide recommendations for best practices and an example of therapists' decision-making process using Kitchener's (1984) model., (© 2013 American Association for Marriage and Family Therapy.)

Youths with autism spectrum disorders (ASD) often engage in serious disruptive behaviors that interfere with their ability to successfully manage day-to-day responsibilities and contribute to relationship problems with caregivers, peers, and teachers. Effective treatments are needed to address the factors linked with disruptive behavior problems in this population of youths. Multisystemic therapy (MST) is a comprehensive family- and community-based treatment approach that has been effective with other difficult-to-treat populations of youths and holds promise for youths with ASD. In this article, we review the broad range of factors associated with disruptive behaviors among youths with ASD and discuss how MST interventions can be adapted to address those factors. We also present a framework for our adaptation of the MST model for youths with ASD. This framework includes a recently completed pilot study as well as an ongoing efficacy trial that together have served to identify key interventions for our adaptation of the MST model., (© 2012 American Association for Marriage and Family Therapy.)

This exploratory, observational study was designed to reveal descriptive information regarding therapists' actual practices with preschool- and school-aged children in a single session of family therapy and to investigate change mechanisms in family play therapy that have been proposed to make this approach effective. A purposive sample of 30 families receiving family therapy was recruited and video-taped during a family session where at least one child between the ages of 4 and 12 was present. Following the session, the therapist and parent(s) completed questionnaires while one of the children (aged 4-12) was interviewed. Session recordings were coded, minute-by-minute, for participant talk time, visual aids or props used, and therapy technique type (e.g., play-based/activity vs. talk-only techniques). Hierarchical regression and canonical correlational analyses revealed evidence supporting the theory that play-based techniques promote young children's participation, enhance the quality of the child-therapist relationship, and build positive emotional experiences in family therapy., (© 2013 American Association for Marriage and Family Therapy.)

Research supports that child parent relationship therapy (CPRT), a filial therapy approach, has strong effects on participating parents and children. Some speculate that filial therapy improves the family system; however, minimal research exists to support this claim. Using a single-case design, researchers examined CPRT's impact on the functioning of 8 families. Results revealed that 6 families experienced statistically significant improvements in targeted areas of family functioning. Results from self-reported measures indicated that 7 families improved in family satisfaction, 4 in cohesion, 3 in communication, and 1 in flexibility. Observational measures also revealed improvements: 5 families in flexibility, 4 families in cohesion, and 4 families in communication. The results support that the benefits of CPRT may extend to the family system., (© 2013 American Association for Marriage and Family Therapy.)