Public Participation: Moving Beyond the Four Walls of Therapy

Family therapists have an ethical responsibility for public participation, to work toward creating a better society. Serving the public interest and developing laws to promote the profession and the public good can be achieved through policy advocacy and political participation. Political and policy work are important but overlooked aspects of family therapy, which is significant given the consequences differing policies have for clients and the profession. This paper reports on results from a random, national survey of licensed family therapists' (N = 174) advocacy actions. Findings indicate family therapists have overarching policy concerns yet lack proactive legislative and activist engagement. The exploration of therapists' actions and beliefs presented in this paper, serves as a springboard for therapists' movement into the public arena. Video abstract accessible by clicking here.

A Brief Report on the Ethical and Legal Guides For Technology Use in 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.

Couples Counseling for Aboriginal Clients Following Intimate Partner Violence: Service Providers' Perceptions of Risk

Interventions for family violence in Aboriginal communities should take a culture-based approach and focus on healing for the whole family. The purpose of this research was to identify risk issues from the perspective of service providers for couples counseling with Aboriginal clients following intimate partner violence. A total of 25 service providers participated in over the phone interviews concerning risk with Aboriginal men in couple counseling. Five concepts emerged including (a) collaterals, (b) commitment to change, (c) violence, (d) mind-set, and (e) mental health. It was concluded that culturally competent interventions should involve the entire community and have a restorative approach. The concepts were compared and contrasted with the available literature.

A randomized clinical trial of family therapy in juvenile drug court

The objective of this article is to examine the effectiveness of 2 theoretically different treatments delivered in juvenile drug court--family therapy represented by multidimensional family therapy (MDFT) and group-based treatment represented by adolescent group therapy (AGT)--on offending and substance use. Intent-to-treat sample included 112 youth enrolled in juvenile drug court (primarily male [88%], and Hispanic [59%] or African American [35%]), average age 16.1 years, randomly assigned to either family therapy (n = 55) or group therapy (n = 57). Participants were assessed at baseline and 6, 12, 18 and 24 months following baseline. During the drug court phase, youth in both treatments showed significant reduction in delinquency (average d = .51), externalizing symptoms (average d = 2.32), rearrests (average d = 1.22), and substance use (average d = 4.42). During the 24-month follow-up, family therapy evidenced greater maintenance of treatment gains than group-based treatment for externalizing symptoms (d = 0.39), commission of serious crimes (d = .38), and felony arrests (d = .96). There was no significant difference between the treatments with respect to substance use or misdemeanor arrests. The results suggest that family therapy enhances juvenile drug court outcomes beyond what can be achieved with a nonfamily based treatment, especially with respect to what is arguably the primary objective of juvenile drug courts: reducing criminal behavior and rearrests. More research is needed on the effectiveness of juvenile drug courts generally and on whether treatment type and family involvement influence outcomes.

TRIAL REGISTRY NAME

Clinical Trials.gov, Identified NCT01668303.

New roles for family therapists in the courts: an overview with a focus on custody dispute resolution

Many legal issues involve conflicts that are at least as much psychological and relational as they are legal in nature. Juvenile and family courts have always embraced a helping philosophy under the parens patriae legal doctrine. These courts address problems where family relationships are central, for example, custody and coparenting disputes, divorce, child abuse and neglect, foster care, intimate partner violence, and juvenile delinquency. Family therapists are playing a growing role in all of these matters. In this article, we use child custody disputes as a more in-depth example for exploring new, potential roles for family therapists, particularly as mediators and parenting coordinators. To show the breadth of the role for family therapists, we also more briefly consider the topics of child abuse and neglect, foster care, juvenile delinquency, and drug and alcohol issues.

Marriage and family therapy: examining the impact of licensure on an evolving profession

Regulatory responsibilities for the profession of marriage and family therapy have shifted from the American Association of Marriage and Family Therapy (AAMFT) to state regulatory boards. The impact of these changes has not been adequately addressed. The purpose of this article is to highlight many of these changes and explore their implications. The educational, experience, and supervision requirements of states regulating the profession of marriage and family therapy in 2007 are examined using descriptive data from 47 regulatory entities and then compared with the current (2012) regulatory standards from 51 regulatory entities. In turn, these are compared with AAMFT prelicensure clinical membership requirements. Results indicate a marked difference between AAMFT prelicensure and state licensure requirements in both 2007 and 2012, but that state requirements continue to evolve. Additionally, the changing roles of the AAMFT and the Association of Marital and Family Therapy Regulatory Boards (AMFTRB) within the profession are explored.

Therapeutic change in Colombian families dealing with violence: therapists, clients, and referring systems in conversation

There is a gap in the Marriage and Family Therapy literature regarding clients', therapists', and family judges' theories of change in relational therapy for family violence. We conducted in-depth interviews with eleven court-referred families, their therapists, and two family judges in Bogota, Colombia. Interviews focused on their expectations of therapy outcomes, their understanding of change, and their evaluation of individual and relational therapy outcomes. We followed a grounded theory approach to data analysis. Analyses showed that therapists, family judges, and clients hold different expectations and theories regarding therapeutic change. Findings are discussed based on existing research on clients' and therapists' ideas about change. Implications for future research and practice are presented.

The psychosocial treatment of parental alienation

Parental alienation occurs in divorces when one parent indoctrinates the child to dislike, fear, and avoid contact with the other parent. Mental health professionals who treat children and adolescents are likely to encounter victims of parental alienation in clinical practice, and it is important to identify and treat these youngsters earlier, when the condition is mild, rather than later, when the parental alienation is almost intractable. This article presents an overview of the treatment of parental alienation, which is called reunification therapy. All the parties involved in the case have a role in the prevention and treatment of parental alienation.

After family treatment drug court: maternal, infant, and permanency outcomes

This study reports on maternal functioning, infant developmental, and permanency outcomes for 52 families following maternal participation in a family treatment drug court (FTDC) for perinatal substance users. Although the majority of families experienced positive child welfare outcomes, over time, maternal functioning deteriorated and infant developmental concerns were identified. Even when promising interventions like FTDC are used, long-term needs of families affected by perinatal substance use need to be considered and addressed.

Physicians vs. Wannabes: TMA sues podiatrists, chiropractors, family therapists

The Texas Medical Association is embroiled in scope-of-practice lawsuits against the regulatory boards of three health care groups. TMA is suing podiatrists, chiropractors, and family therapists.

How effective are family treatment drug courts? Outcomes from a four-site national study

Family treatment drug courts (FTDCs) are a rapidly expanding program model designed to improve treatment and child welfare outcomes for families involved in child welfare who have substance abuse problems. The present study compares outcomes for 250 FTDC participants to those of similar parents who did not receive FTDC services in four sites. Results show that FTDC parents, compared to comparison parents, entered substance abuse treatment more quickly, stayed in treatment longer, and completed more treatment episodes. Furthermore, children of FTDC parents entered permanent placements more quickly and were more likely to be reunified with their parents, compared to children of non-FTDC participants. Finally, the FTDC program appears to have a "value added" in facilitating positive child welfare outcomes above and beyond the influence of positive treatment experiences.

Innovative approaches to identifying and responding to the needs of high risk youth

Following a critical review of key issues facing the delivery of effective, cost-attractive services to high-risk youth, and research addressing these experiences, we identify some innovative approaches to identify and respond to the multiple needs of these youth. The importance of providing family services with an ecological focus is stressed. Further, some exciting developments occurring in juvenile assessment centers. involving screening and in-depth assessment, as well as intervention strategies are presented. These innovative developments include for the Tampa Juvenile Assessment Center: 1) a family empowerment intervention service for arrested youth; 2) a family-focused early-intervention, intensive case management service for youth entering a diversion program; and 3) for the Miami-Dade Juvenile Assessment Center, the comprehensive program of research and program development occurring in the context of the National Demonstration Project. We conclude with a discussion of major issues facing the field and the continuing need for a national commitment to help the many troubled youths entering the juvenile justice system.

Child custody evaluations

Because divorce is so common, it is important for our society to find ways to minimize the psychological trauma that is experienced by children of divorced parents. Ideally, divorcing parents would not fight so much over the children, in front of the children, and through the children. When disputes do arise regarding custody, visitation, and parenting plans, mental health professionals can assist the judges who make the final decisions by performing competent custody evaluations. These evaluations should be conducted in a systematic manner, should consider several critical factors in an unbiased manner, and should result in recommendations that promote the best interests of the children. In most cases, the goal is for each child to have strong, healthy relationships with both parents. After conducting an evaluation, it is usually possible to make recommendations regarding custody, parenting arrangements, and forms of counseling and therapy that should be helpful to the family members. It is important to communicate these recommendations in an articulate manner, whether verbally or in the written report.

The family group conference in the New Zealand children, young persons, and their families act of 1989 (CYP&F): review and evaluation

The family group conference is an innovation introduced into New Zealand law as a means of resolving child protection and youth justice cases. The law requires the conference to include the offender, the victim, the extended family, and other relevant parties. This article reviews New Zealand research and commentary, and publications reporting on experiences with the methods in other countries. The discussion emphasizes problems in adapting a method based on one culture to a different culture and social organization. The article also considers the law from the viewpoint of therapeutic jurisprudence. Although the research is sparse, the FGC has strong promise for resolving problems, enhancing the sense of community and participation, and empowering families.

Violence or discipline? Working with multicultural court-ordered clients

Therapists working with court-ordered clients from cultures differing from the mainstream face challenging issues of compulsory therapy in the context of cultural diversity. This article reviews the literature on court-ordered and multicultural counseling, highlighting central elements of both. It then suggests guidelines that blend these elements. The author illustrates how using these guidelines can enable therapists to engage these clients in the therapeutic process and focus on culture as the context for change.

The importance of cultural sensitivity and therapist self-awareness when working with mandatory clients

Systemic therapy emphasizes the importance of understanding each relationship in the context of its ecosystem. Considerations such as the influence of social agencies, culture, and the therapist's self-awareness are described in the literature as amplifying lenses within the therapeutic relationship. When a minority client is caught in the web of larger system agencies and is mandated to family therapy, systemic family therapy, which incorporates multiple lenses and attends to the context of social background, may provide a better understanding of the client's reality. Clinical cases show that therapists may slip into veiled racist and discriminatory attitudes with minority clients. Self-awareness, "soul searching," and appropriate supervision may be of tremendous help in learning from such experiences. A case example illustrates the application of this approach.

Assessment of parents and young children (Children Act 1989)--a child psychotherapy point of view

The criteria used by professionals in assessing child care cases are not always made explicit, partly because of the ambiguity of the terms 'vulnerability' and 'at risk'. This paper presents a child psychotherapy view of what professionals may look at in terms of the interactions between parent and young child and how these may be understood. 'Reasonable expectations' of child development and parental care are considered. In terms of the child, overall attachment and communication needs and the specific developmental phase in terms child's maturing cognitive and socio-emotional functions are emphasized. In terms of the parent, the capacity to see the baby as separate from their own internal conflicts and to reflect upon the infant's mental state are seen to be pivotal to the infant's psychological well-being. The authors discuss the unconscious re-enactment of malignant patterns from the past through the relationship with the baby, and why parents are sometimes unable to avoid this. Finally, the authors suggest that assessment of the capacity for change in vulnerable parent-infant constellations must take into account the baby's developmental timetable.

Factors related to family therapists' breaking confidence when clients disclose high-risks-to-HIV/AIDS sexual behaviors

This national survey of 309 marriage and family therapists examined what therapists do when their HIV-positive clients disclose that they are engaging in high-risk sexual behavior. The participants were given vignettes in which a fictitious client told the therapist about engaging in unprotected sex. Although the basic situations were the same, the client variables of age, gender, race, sexual orientation, and HIV status were systematically varied. The participants were more likely to break confidence regarding unsafe sex practices when their clients were male, young, gay, or African American. Moreover, therapists who were more likely to disclose were older, female, had less experience with gay/lesbian populations, were Catholic, were very religious, and were more likely to practice in urban areas. The authors discuss the implications of these and other findings.

Marital conflict by proxy after father kills mother: the family therapist as an expert witness in court

The father killing the mother leaves the children effectively without parents. The extended family from both sides will often intervene to offer a home for the children, or at least to have a say in what arrangements are made for the children and how they are to be brought up. Intensely competitive and hostile feelings between the opposing sets of relatives are commonly aroused, and the children may be caught up in a battle reminiscent of the conflict between their parents, which culminated in the death of their mother. I and my colleagues have, as a team, seen more than 300 children who have lost one parent at the hands of the other, and we have been involved in subsequent custody battles as expert witnesses. Based on this experience and using this context as an example, the issues for the family therapist as expert witness in adversarial Court proceedings are presented. A case is described that illustrates the theoretical exposition--including the effectiveness of family therapy from the witness box.

[Sex offenders in legal treatment and their relatives: results of family therapy sessions]

Members of the family of origin and spouses have been invited to take part in a cognitive-behavioral treatment programme for incarcerated sexual offenders to support the offender. Offenders arranged appointments with their spouses, mother, fathers and the therapist. A one-year follow-up reveals considerable change in denying and minimisation of responsibility, forcefullness and degree of sexual intrusiveness of both the offenders and the spouses. Both groups showed a better understanding for and a more positive attitude to the offenders' sexuality. Furthermore, both groups showed a significant increase in applying concepts of relapse prevention.

[Conflicts between parenteral expectations and children's needs in child guidance clinics]

The central question of this article is whether the Law for Children and Youth Aid (Kinder- und Jugendhilfegesetz KJHG) from 1991 is justly accused of being more a Law for Parent Aid than a law in keeping with the times which also does justice to the problems and needs of children. The article especially pursues the question whether the legislator of the KJHG considers the precarious balance of a conflict between parental rights and children's welfare as required by the constitution. Whether the child's welfare is endangered in an individual case and which strategies to limit further dangers are promising can often only be answered in an interdisciplinary manner; competencies from child psychologists and child psychiatrists should be utilized more extensively to determine problems and find decisions in youth care.

Whatever happened on the way to counselling? Hurdles in the interagency environment

A study of confirmed cases of child sexual abuse showed that only 56% of children received an appointment at a counselling agency in spite of explicit policy guidelines that children have an opportunity for counselling in the aftermath of the abuse. The study revealed that problems created at all levels within the interagency environment led to children becoming "lost" in the system and not receiving the services from which they could have benefited. Particular attention is given to changes in the broader policy and resource context which have ramifications at the local interagency level and in the services provided for sexually abused children.

[Work with psychiatrically ill parents in a pediatric psychiatry treatment facility]

Since the new law for hospitalization has come into effect (1991) in Austria more than before children from parents who have psychoses or other serious mental disorders have to be taken into in-patient wards in psychiatric institutions for children-often according to a court decision. This article discusses the cases of 21 such children and their 16 (respective) families. The various difficulties in dealing with the mentally ill mothers and fathers as well as some first experiences with possible strategies for working with these parents, which were gathered in therapeutic practice, are described individually. Work with these parents means trying to establish reality or risking losing reality.

[Child guidance between counseling and official participation]

The introduction of the law about youth services has led to a coming closer of educational guidance services and the other institutions for youth services. This development is leading to a new discussion about the relationship between the educational services and the youth welfare office. There is a danger, by specific laws, the traditional working principles of educational guidance services, such as voluntary use and easy accessibility, might lose their importance. But only than can educational guidance be helpful for the other youth services if its principles of working remain valid. By examples of certain cases is shown, how cooperation might work between educational services and youth welfare department. The article tries to show a means of how to fulfil the demands of participation as required by the youth welfare law on the one hand and how to preserve the special institution of educational guidance on the other hand at the same time.

The link between domestic violence and child abuse: assessment and treatment considerations

This article discusses the existence of both spouse abuse and child abuse within families. Recent research suggests that practitioners have often missed the coexistence of these problems within their caseloads. Practice implications for both domestic violence service providers and child welfare professionals are outlined. Recommendations for changes in assessment procedures, treatment planning, and implementation are made.

Proposed revisions to mandatory reporting laws: an exploratory survey of child protective service agencies

Mandatory reporting laws have created a difficult dilemma for many mental health providers (MHPs). Professional ethics, confidentiality, and the best interests of the client are often seen as conflicting with the legal obligation to report child abuse. The receptivity of child protective service (CPS) agencies to three alternative MHP reporting strategies was assessed in a national survey. The results indicate strong support for the current model of reporting and marginal support for alternatives that supply the MHP and the family with more latitude in determining when to report and how reports are handled. The results are discussed in relation to what many MHPs see as the need for more integrated, flexible, and cooperative approaches to the protection of abused and neglected children.

[Rules of specialty skills in psychosocial counseling of children, adolescence and parents]

This article is a revised version of a short expert opinion of the Ministry of Work, Health and Social Matters of the state of North Rhine-Westphalia (West Germany) dealing with the rules of expert skills in educational counselling. After the attempt of clarifying terms (consultation, therapy, medicine) the processes of consultation and treatment are described in general as influencing in a communicative way, whereby common qualitative characteristics are pointed out. The author also goes into taking ethical principles into consideration, possibilities of preventive effectiveness and consequences for education and further training of experts working in educational counselling facilities.

[The ethical status of the child in family and child psychotherapy]

The implications of the United Nations' Convention on the Rights of the Child for psychotherapy and family therapy with the children are elaborated. Referring to the ethical discourse about patient information and informed consent, the authors suggest to integrate minors into decisions about participation in and goals of therapy. Shortcomings of common ways in dealing with minors in therapy are analyzed and discussed in the light of ethical principles. Empirical data concerning adequate judgments about competences of children are evaluated and suggestions for practical work in therapy and counseling are presented.

Ethical issues in family law

This article focuses on a few key ethical issues which arise in the context of family law. One of the issues faces mental health practitioners who are often engaged as expert witnesses in family law disputes. In another realm, family law attorneys face several fundamental ethical dilemmas in the course of their work. The client's right to appropriate treatment will be considered in the light of multidisciplinary services. On a broader level, the courts need to examine the ethical implications of the commonly used guideline in judicial process, 'the best interests of the child'. When these ethical issues are considered, it becomes clear what changes need to be made in individual practice, professional standards and social policy. The underlying premise is based on the knowledge we have gained in recent years through research and clinical experience with divorcing families. It is suggested that a radically different approach to society's handling of divorce is needed. Denmark's administrative handling of these problems is presented as a working alternative model.

Confidentiality: an ethical and legal conundrum for family therapists

There are several important issues influencing the holding of confidences in family therapy, among them are privacy, family secrets, confidentiality, and privileged communication. Clinicians need to be aware that breach of confidentiality is considered a high-risk area in clinical practice, which could be brought within a "low profile" malpractice configuration by adopting certain risk management techniques. Family therapists have an obligation to maintain their practice under the guidance of professional ethics, agency policies/procedures, and within emerging judicial parameters. The questions of confidentiality that confront family therapists have no clear and easy answers and the legal dilemma is ever present.