It’s time for another research roundup!

This Spring, I taught Research and Analysis for the first time, to graduate MFT students. And, as expected, I enjoyed it! I realize, as a former student myself, that grad students come to Research with many misconceptions. So, I began the first class with Brené Brown’s The Power of Vulnerability.

Brown’s talk completely changed my view of research when I was a doctoral student, and I hoped it would offer inspiration to my new Research learners. She tells a story not only about vulnerability, but also about research as a relationship involving the researcher, her participants, and a larger conversation that is happening between them—a dialogue. The dialogue can be transformational, if the researcher pays attention—which, is the central theme of Brown’s talk.

Nevertheless, I share this to give some context to these research roundups. I read, mainly the Journal of Marital and Family Therapy (JMFT), to stay on top of the latest information in my field. But, I also contemplate research—formal and informal, as a contributor to personal and professional growth. I am grateful for those “out there” conducting research, and invite you to dig into what research can offer your practice this summer.

Below are brief summaries of five articles I read this past semester for my own learning, and/or to support students’ learning.

Partners in the spiritual dance: Learning clients’ steps while minding all our toes

The authors present three clinical cases to illustrate the complexity involved in and resulting from the interaction of clients’ and therapist’s spiritual beliefs. A recognition of the struggle, nuance, difference, similarity, and centrality of spirituality for therapists and clients is essential to respectfully exploring spirituality, together. The cases are presented in the article by the treating therapist, using the outline: Self of the therapist, model, case description, and reflections. Organizing the therapist’s location--spiritually, personally, and professionally, during their work on the case proves vital to discovering how conversations about spirituality are influenced and developed by all parties in therapy. The authors recommend “spiritual self-awareness” as a competency for therapists.

Keeling, M. L., Dolbin-MacNab, M. L., Ford, J., & Perkins, S. N. (2010). Partners in the spiritual dance: Learning clients’ steps while minding all our toes. Journal of Marital and Family Therapy, 36(2), 229-243.

Covenant attachment: A constructivist grounded theory of Christian couples and God

Seeking to develop an attachment, systemic theory about God within the relationship of marriage, the authors conducted a study with nine heterosexual couples from varying Christian denominational backgrounds. They asked the following initial questions during conjoint interviews:

“Can you tell me about how you have experienced God in your relationship with each other?

Can you describe the role God plays in your relationship?

Can you describe both your relationship with your partner and your relationship with God?”

Follow up questions were:

What is it about your spouse’s relationship with God that you like the most or that affects you the most?

When do you feel closest to your spouse spiritually?

What do you do to achieve that?

The resulting theory offers a framework for attachment that incorporates God into the marital relationship. The researchers explain how individual cognitions, emotions, and relationship with God are lived out by spouses in couple behaviors, and eventually, couple behaviors toward God. In regard to couple therapy, this model helps therapists think through the couple-God relationship within the framework of attachment theory, considering individual-God, spouse-spouse, and couple-God attachment styles.

Maxwell, M. D., Davis, S. D., Miller, M. M., & Wooley, S. R. (2020). Covenant attachment: A constructivist grounded theory of Christian couples and God. Journal of Marital and Family Therapy, 46(1), 110-123.

Clinical and ethical considerations for delivering couple and family therapy via telehealth

Through case examples that address specific challenges occurring during telehealth sessions, the authors offer recommendations for best practices. For example, for the telehealth challenges of: “need for individual assessment” and “difficulties joining with the couple/family,” the authors include an initial in-office visit among their suggestions. The authors also give a brief overview of privacy, confidentiality, and safety considerations for therapists.

One way in which telehealth reduces barriers, according to the authors, is in the area of skills-building. They make the point that skills-building during telehealth sessions may result in improved outcomes, since the skill is being both taught and practiced in the same environment —the clients’ home.

Although this article was published in 2019, it includes several ideas which could be considered outdated during the COVID-19 pandemic, such as in-person initial visits, and mailing documents to clients. Research that offers best practices when only electronic means are an option would serve therapists and clients who do not have in-person options, and/or would like to offer services remotely.

Wrape, E. R., & McGinn, M. M. (2019). Clinical and ethical considerations for delivering couple and family therapy via telehealth. Journal of Marital and Family Therapy, 45(2), 296-308.

Results of Gottman Method Couples Therapy with gay and lesbian couples

This study was a collaboration between the Gay Couple Institute in San Francisco, CA, and the Gottman Institute, through the use of Gottman Method Couples Therapy. The study involved 88 gay couples and 18 lesbian couples who received therapy by a Gottman-trained therapist for an average of 9 sessions. Therapy addressed friendship/intimacy, conflict, and shared meaning. The researchers measured relationship satisfaction four times during the study, using the Locke-Wallace Marital Adjustment Test. Improvement of marital satisfaction was statistically significant. The authors say, “the effect sizes of marital therapy tend to be on the order of a standard deviation and our results are twice that size” (p. 690). The authors conclude this result is due to factors unique to gay and lesbian couples, including: less inequality and gender role differences, couple therapy is “more powerful” with same sex couples, and power dynamics and benevolence are more central to emotional and communication dynamics.

Garanzini, S. Yee, A., Gottman, J., Gottman, J. Cole, C., Preciado, M, & Jasculca, C. (2017). Results of Gottman Method Couples therapy with gay and lesbian couples. Journal of Marital and Family Therapy, 43(4), 674-684.

The condensed MFT core competencies: A streamlined approach for measuring student and supervisee learning using the MFT core competencies

Motivated by simplifying the existing MFT core competencies for regulators, administrators, and programs, the authors used descriptive qualitative research analysis to condense 128 competencies to 16. The authors searched for themes within the existing competencies, in order to further categorize and distill the core competencies. The initial idea to condense the competencies was suggested to the authors during a workshop at the AAMFT National Conference. Additionally, the initial 17 competencies generated by the analysis were edited after further feedback was offered at a subsequent annual conference. The new, streamlined competencies center more on competent MFT practice than the process of therapy. The authors include a chart of the new 16 condensed competencies, as well as an explanation for each in this article.

I have used the full list of 128 competencies in the past for courses and supervision, and it can lead to “information overload” for trainees and post-grad therapists. I see this new list as helpful for organizing training and learning for both faculty and students.

Northey, W. F., & Gehart, D. R. (2020). The condensed MFT core competencies: A streamlined approach for measuring student and supervisee learning using the MFT core competencies. Journal of Marital and Family Therapy, 43(4), 674-684.

From the book club

Letters to a Young Therapist

Organized as letters written throughout the seasons of the year, this book is a journal from an experienced therapist to a young therapist. The book includes lessons on self-care, client loss, couple work, ethics, self-disclosure, training, and more topics that are central to a therapist’s life, career, and longevity. This is a useful read for graduate students, post-graduate therapists, and early licensed therapists, because the author addresses conflicts and personal challenges inherent in the work of therapy.

Pipher, M. (2016). Letters to a young therapist. Basic Books.

Suggestions for further reading:

Accompaniment to articles on spirituality:

Griffith, J. L., & Griffith, M. E. (2003). Encountering the sacred in psychotherapy: How to talk with people about their spiritual lives. Guilford Press.

Accompaniment to Gottman Methods article:

Coontz, S. (2020, February 13). How to make your marriage gayer: Same-sex spouses feel more satisfied with their partners than heterosexual ones. What’s the secret?. The New York Times. https://www.nytimes.com/2020/02/13/opinion/sunday/marriage-housework-gender-happiness.html

Let’s Chat

Let me know in the comments below:

Which article, or topic, stands out as important to you right now?

How To Address Therapy Clients' "Undercurrents" and Stress In Therapy

Feeling confident when offering therapy to families is a goal for many therapists and counselors. When we face the limitations of an individual perspective on treatment, we are left to wonder, “What theory, or techniques, can help this client comprehensively?”

Dr. Scott Sells explains two techniques from the Family Systems Trauma Model (FST) that will reframe family problems and help lead to second-order change. FST is applicable to your work whether you see individuals, couples, or families.

Treating Traumatized Families: An Introduction to the Family Systems Trauma Model (FST), with Dr. Scott Sells

Dr. Scott Sells, PhD, LCSW, LMFT is my interview guest for this post. He is the founder of the Family Systems Trauma Model, and the Family Trauma Institute, as well as the author of three books on methods for treating families and children, within the context of family therapy.

By watching this video, or reading the transcript, you will learn:

A working definition of the term traumatized family
Three essential steps you may be missing in your clinical work with families.
One thing you can do right now to improve engagement and outcomes with your family clients.
How to learn more techniques that will reinvent your family therapy work.

The Importance of Using Metaphors and Metaphoric Tales as a Therapeutic Intervention

Metaphor is a figure of speech that consists of naming, describing, or qualifying something through its similarity or analogy to something else. It’s not just about songwriting or poetry-- we use metaphors all the time. After all, we all “fall in love” or “get stuck” at some point in our lives.

In the psychoanalytic approach, metaphors have always been very important, since the unconscious mind is

Are Gottman Method and Emotionally Focused Therapy (EFT) Compatible?

Couples counseling today is so much more effective than in decades past. There is almost too much information out there to guide therapists. It can be overwhelming.

I have seen many discussions about two of the main therapeutic models for couple therapy: Sue Johnson’s Emotionally Focused Couple Therapy, and John and Julie Gottman’s Gottman Method. The discussion can be, like so many discussions, very polarized at times. But there is such a richness and joy to learning from both (not to exclude all of the other contributors to the field right now) that the idea of folding together some of what these models offer seems inevitable.

Family Therapy Basics Research RoundUp: Summer 2019

Periodically, I write summaries of the latest research articles that I’ve read (mainly from the AAMFT). This article is a roundup of my recent summaries.

The references listed are from the most current issues of the Journal of Marital and Family Therapy, and I also include a quick summary of a recent book I read in the book club. While MFTs are referenced throughout the summaries, the information is relevant to all psychotherapists, regardless of discipline.

Linear vs. Circular Causality: Systemic Therapy Series

Lately, I’ve been reviewing the history of the marriage and family therapy (MFT) field. Including the stories of MFT pioneers, the shift represented in the field from treating the individual to treating the system, and the core concepts that mark systemic thinking and systemic therapy.

It’s been fun!

I’ve decided to begin a systemic therapy series to review the major concepts of systems theory, as well as how to begin and maintain the systemic perspective.

Steps for Assessing and Fostering Family Resilience in Therapy

Resilience is defined as “The ability to rebound from crisis and overcome life challenges” (Walsh, 2006). It includes a person's sense of hope, support systems, relational encouragement, and emotional endurance.

When families face a crisis, the members' willingness and ability to communicate honestly, tolerate uncertainty, and respect one another's differing needs both define and develop the family unit's resilience during and after the crisis.

In this post, I offer a relational definition of resilience, as well as frameworks for assessing and fostering resilience.

Mindfulness-Infused Therapy: 4 Approaches

You (the readers) have been asking for mindfulness-based interventions to use in your work with groups, networks, or individuals. Today, I am providing a summary of four popular mindfulness-infused approaches, backed by research, that can assist you in enhancing your change-based interventions with clients. These four approaches are: Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, Acceptance and Commitment Therapy, and Dialectical Behavior Therapy.

The Therapist's Battle for Structure and Initiative: A Review

In their now classic family therapy text, The Family Crucible (1978), Napier and Whitaker outline two main “battles” between therapists and clients: The battle for structure and the battle for initiative.

At the time of their writing, concepts of resistance and unconscious processes were accepted within the family therapy field; this may have been due, partly, to the fact that many family therapy pioneers were trained as psychiatrists. While family therapy has moved beyond these views of the therapist-client relationship, there are still ways in which family therapists can use Napier and Whitaker's "battles" to inform and enhance their work.

Appreciative Inquiry: How to Facilitate "Powerfully Positive" Change in Therapy

Appreciative Inquiry (AI) is an approach to change that invites "what gives life" to people and systems to be noticed, discussed, and owned. This specific style of inquiry involves, "the art and practice of asking questions that strengthen a system’s capacity to apprehend, anticipate, and heighten positive potential” (Cooperrider & Whitney, 2005). The goal of AI is to build an appreciation--a positive core--within groups .

Solution Focused Brief Couples Therapy Tips, with Elliott Connie

Elliott Connie is a Solution Focused Brief Therapy (SFBT) practitioner, author, and speaker. He developed an approach to couples work that distills the essence of SFBT into guiding principles for working with couples.

As a therapist who loves working with couples, I am always interested in ways to enhance my couples therapy skills. For this reason, I invited Elliott to explain the reasons why SFBT is his choice for working with clients, as well as how it creates a contrasting experience for couples that have a history in therapy.

Four Systemic Steps for Addressing Anxiety with Therapy Clients

From a systems theory perspective, we, as individuals, exist within a network of relationships and relational interactions. It is within these relationships that problems occur and reside; it is also within these relationships that solutions are generated and maintained (Becvar, 1998).

A systemic approach for guiding clients through addressing, managing, and living well with anxiety takes into consideration not only clients’ relationships with themselves and significant others, but also their relationships with anxiety.

10 Therapist (and Child)-Approved Activities to Support Kids with Anxiety

If you’re a mental health professional working with children, you will probably agree that many of the calls you receive from parents have something to do with anxiety or stress. Child therapists have the amazingly important yet challenging task of educating and supporting kids in a therapeutic setting that is both productive and fun. When working with children as young as preschool age, it can be a very daunting task to keep things fresh and exciting week after week! So, how do we help children develop the coping skills they need while keeping them engaged (and not glancing at their watch)? Here are ten therapist (and child!)-approved, fun activities that address anxiety-based disorders and promote relaxation and stress reduction in children:

The Art and Science of Therapy as Craft, Part 2: Crafting Questions

For this week's video chat, Dr. AnnaLynn Schooley returns to discuss therapy questions as an intentional craft, and she covers four basic question types: single answer, open, closed, relational, and circular.

Therapist Self-Disclosure Simplified

Self-disclosure is a touchy subject among therapists. Some therapists never self-disclose, while others feel stifled by having a rigid boundary around self-disclosure. As I consider self-disclosure in therapy, I ask myself, “When is self-disclosure appropriate?” “How does self-disclosure deepen the therapist-client connection?"

Family of Origin Exploration for the Therapist: How to Create Your Genogram

In article three of the Family of Origin for the Therapist series, you learned 3 simple steps for how to begin family of origin (FOO) exploration: 1) read Bowen’s chapter, 2) observe your FOO experience, and 3) reflect on what you learned. Hopefully, your curiosity has led to significant understanding.

Understanding is the foundation of Bowen Family Systems Theory (BFST). Bowen (1985) believed that if clients could understand themselves as members of their FOOs and as created by their histories, they could begin and continue significant change.

In today’s post, I offer the next step in developing understanding: Creating your genogram. I explain how to create a basic genogram that you can expand as you continue your exploration.

5 Tips for Keeping Up with Therapy Paperwork

In my interaction with therapists as a mentor and supervisor, I’ve learned that one of the main struggles therapists face is having too much work and not enough time. Many therapists find themselves overwhelmed by documentation responsibilities, in particular; this includes completing client notes, referrals, billing, treatment plans, etc.

In today’s post, I offer several strategies for keeping up with paperwork, so that you can stay on track and avoid the stress of falling behind.

Solution-Focused Brief Therapy Client Types, and Their Relevance To Every Session

In her 1989 article, Of Visitors, Complainants, and Customers, Insoo Kim Berg details three types of “client-therapist relationships” (p. 21). Her wording is significant, because she is not labeling clients; she is describing them in terms of their relationship to the therapist, the process of therapy, and the problem. These three relationships have undergirded Solution-Focused Brief Therapy theory and interventions over the years, although they are not consistently discussed in newer works. The client relationship types are widely applicable to therapy, regardless of theoretical orientation, making them one of the most useful concepts in marriage and family therapy.

In this post, I present a review of these client types, and I explain their relevance to and usefulness for all therapeutic sessions.

How to Ethically Offer Coaching as a Licensed Therapist: A Step-By-Step Guide

One of the most common professional goals for my clients is expanding their private practice to include life coaching services. As professionals with a depth of knowledge in personal development and goal achievement strategies, therapists are ideal candidates for the coaching profession. Despite this near perfect fit, there are some important ethical consideration for therapists when offering coaching services alongside therapy, or when choosing to become professional coaches. In this post, I focus on offering solutions for these complications, in an effort to help you ethically practice coaching.

5 Step Plan for De-escalating an In-Session couple Argument

Most of us, therapists, have been there: A simple disagreement turns into an all-out screaming match in the middle of a therapy session. This is, thankfully, not a common scenario for most therapists, but it’s also not rare--especially for therapists who specialize in couple therapy.

In this post, I cover steps for disrupting an argument occurring in a couple therapy session. Intervention on the part of the therapist is necessary during some conflicts, because the arguments can cause further damage in the couple relationship. And, if therapists allow arguments to continue for too long, they can affect the couple’s sense of safety when in therapy.

The main goals of intervention in this case are to: