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Therapeutic Change

Determining the primary mechanisms contributing to therapeutic change is a central topic within marriage and family therapy (MFT), and psychotherapy literature.  The MFT concept of therapeutic change is the transition from a pathological to a functional family system through the therapist’s interventions.  Research studies show virtually every type of psychotherapy, including MFT, has proven to be more effective than no treatment.  Efficacy research demonstrates that although MFT works, we know little about why it is effective.

In the current era of accountability, an adequate explanation of the process and mechanisms that contribute to the complex process of change is particularly relevant.  A main component of accountability in MFT practice is unification within the field on the fundamental question of how the therapy MFTs provide leads to client change.  Determining a common set of factors to explain successful therapy would be a major breakthrough; serving to simplify and focus practice, training and research.  Identifying common ingredients to explain the complexity of MFT practice holds potential to unify competing theoretical schools.

Carissa D’Aniello is a graduate of  Fairfield’s Marriage and Family Therapy Program.

The Importance of Empathy

The marriage and family therapy literature recognizes, almost universally, that empathy is the cornerstone of an effective therapeutic alliance. Empathy is summarized in the literature as the ability to empathize with others: the ability to sense another’s world as if it were their world – a critical process to all human relationships and an essential ingredient. According to researchers, when empathy is operating on three levels – interpersonal, cognitive and affective – it is one of the most powerful tools therapists have at their disposal since it helps clients pay attention and value their experiencing, see earlier experiences in new ways, modify their perceptions of themselves, others and the world, and increase their confidence in making choices and pursuing a course of action. It is the therapist’s ability to ‘reflect’ the experiences of clients then, that helps produce in clients’ self-understanding and clarification of their beliefs and worldviews.

Poverty, Family Stress and Family Therapy

Family therapy researchers and clinicians have demonstrated, for close to fifty years, how increased levels of family poverty lead to increased levels of family stress, which, if not managed optimally through a sound family structure, family resilience, and effective support networks, could contribute to familial and individual dysfunction (Minuchin, 1967; Aponte, 1994; Minuchin, 1998). In the mid to late 1960s Malone (1963) and Minuchin (1967) found that poorly structured disorganized families had children who showed predictors of chronic acting out and impulse disorder (i.e. low levels of frustration tolerance). It is important to note that family structure in the field of family therapy refers to transactional patterns among interrelated subsystems within the larger family system. This definition diverges from the often-utilized conceptualization of family structure, which relies heavily on physical membership of the family system (i.e. single parent family, intact family, extended family, etc.).

Family therapists believe that restructuring a family system will increase the functionality of all members of the system and the system as a whole Contemporary research has validated this belief. For example, there has been extensive research that shows that an optimized family structure has a significant impact in reducing adolescent delinquent behaviors, conduct disorder, and alcohol abuse (Sexton and Alexander, 2003). It has also been found to be effective in decreasing truancy and out of home placements, and increasing school performance (Henggeler, Sheidow, and Lee, 2007). Family therapy interventions have been found to be both effective and efficient in diminishing negative developmental outcomes in minors.

WHAT WE KNOW: SUBSTANCE ABUSE AND CHILDREN

Children of parents who are chemically dependent are prone to developing externalizing symptoms, such as attention problems, aggression, delinquency, and/or low academic performance.  Also prevalent among the children of parents who abuse drugs are manifestations of poor social and intellectual functioning. Several scholars have examined how genetic and environmental factors, such as parental attitudes, act as predictors of future drug and alcohol use in the children of substance abusing parents.

Related outcome studies have mainly focused on a child’s level of risk for becoming chemically dependent. These studies have found a significant relationship between parental alcohol/drug habits and the subsequent increase in adolescent use. Additionally, substance abuse in parents may influence the severity of drug dependence in children. However, despite the links between parental drug and/or alcohol use and children’s future use, Zucker, Wong, Putler, & Fitzgerald (2003) found that resilience in these children proved to be a protective factor that countered the risk of future drug and/or alcohol use.

Researchers have shown that the influence of parental attitudes on children’s drug seeking behaviors may be as important as current parental substance abuse. When parents discover that their children are using drugs and do not intervene, this dynamic facilitates continued drug use. These findings provide evidence that the interactions between children and their parents can impact future substance abuse. Researchers also found that the way children perceive their parents and their substance abuse may be correlated with their own future substance use.

2010 Fairfield University MFT Trip to London

In January 2010 a group of 5 students, 1 alum and one professor traveled to London, England for a study visit to the Marlborough Family Services, mental health agency.  The  thrust of the trip was to learn about the Marlborough’s theoretical approach and the logistical workings of their outreach programs in local schools. In particular, their work with families who have a child who had been identified as at risk for academic and/or behavioral issues. Instead of outsourcing mental health services that may be resisted by families and children alike, the idea is to intervene in a non-stigmatizing manner by holding family group meetings in the school.  The group format lends itself to forming a community of  students and parents who may be struggling with similar issues thereby creating a supportive community of peers.  Goals for the groups are to utilize a systemic, group orientation to provide parenting education, psycho-education, problem solving skills, prevent escalation of behavioral and education problems, minimize suspensions; essentially to seize the opportunity of “nipping issues in the bud”.

The school based meeting are run by systemically trained therapists who work in collaboration with a school partner, usually a teacher, who champions the program to school administrators and teaching colleagues. The school partner works as a point person between the school and the agency.  Once teachers understand the goal of the family groups they are encouraged to refer students and their families to the program.  The in-school meetings are run similarly to the way the Marlborough’s on-site school for children aged 5 – 17 runs.  Parents spend some time working with their child on some academic work and in the process obtain an understanding of the type of work being asked of their student and challenges the child faces in doing the work.  Then the whole group gets together to discuss challenges they face as well as goals and strategies for obtaining these goals.  The role of the therapist and the school partner is to model, guide and enhance communication, set clear expectations and parent/child collaboration.The Marlborough Model emphasizes the need to view childrens’ needs in the context of the environments at home and at school, not simply in relation to the children themselves.

The Marlborough Family Services agency is funded by the British government and is often cited for their successes in working with difficult populations.  Their model is deeply systemic and collaborative.  They utilize family groups in working with families entrenched in the social services system who struggle with multiple problems such a poverty, dual diagnosis, incarceration, custody disputes, domestic violence, to name a few.  We were all struck by the skills and dedication of the Marlborough staff that we met, Eia Asen, Brenda McHugh, Neil Dawson, Serena Potter and Anthony Scrafton.  Clinicians are supported in utilizing creative techniques to heighten awareness of and interrupt unproductive patterns of interaction and ways to manage cultural gaps in understanding.   Clinicians interventions include video taping, home visits, ice breaking/team building exercises, group play, group meetings in which goal setting and strategies for success are collaboratively formulated and written on easels. Reflection is a part of all exercises. Goals are called ‘targets’ and target attainment is rated by teachers on a daily basis as a measure of progress and a means by which teachers communicate their assessment of  the students work and effort each day. Target reports are sent home to parents each day and are reviewed at family meetings which take place once a week,  every two weeks or once a month, depending on the school group.

Back Row: Marie Fennell, Eia Asen (Director of Marlborough Family Services), Ingeborg Haug (Professor, Fairfield University MFT Program), Carol Passmore. Front Row: Laura Fishman, Susan Valentino-Hersey, Kerry Bordak, Sarah Arsenault

Back Row: Marie Fennell, Eia Asen (Director of Marlborough Family Services), Ingeborg Haug (Professor, Fairfield University MFT Program), Carol Passmore. Front Row: Laura Fishman, Susan Valentino-Hersey, Kerry Bordak, Sarah Arsenault

All in all, the learning at the Marlborough Family Services was exciting and inspiring.  I speak for myself, but I think the group would be unanimous in recommending this trip to anyone interested in working in schools. The Marlborough Model has been developed over the the course of 30 years and is based on the success of the multi-family group model that proceeded it.  There is hope of making the trip an annual event and in establishing a collaborative partnership between the Fairfield University MFT program and the Marlborough Institute. If you get the opportunity, go!!

The Staggering Costs of Addiction

The yearly costs of chemical dependency, including medical care, premature death, unemployment, criminal justice involvement, and addiction treatment, is estimated to be over 165 billion dollars and 50,000 lives per year (Landau et al., 2000). According to national statistics, over 12 million children are currently estimated to be living in homes where at least one parent has used an illicit psychoactive substance (Substance Abuse and Mental Health Services Administration, SAMHSA, 2004). Children of parents who abuse drugs are directly impacted by the implications of parental addiction and its affects on the family environment.

According to the National Association for Children of Alcoholics (SAMSHA, 2004), families of substance abusing individuals have higher degrees of relational conflict. Children in these families are often exposed to chaotic environments that offer little stability or emotional support, thus rendering them more vulnerable to experiencing emotional and physical abuse or violence. Additionally, families with parents who abuse drugs show decreased family cohesion and family organization and are more likely to be isolated from their extended family and community.

Spring Student Networking Breakfast!

Please join us for …

CTAMFT Student Committee Sponsoring

NETWORKING BREAKFAST for MFT students and Post-Graduates 

 “Life After MFT Graduation”

Saturday, April 24th   9:30am-12:00pm

Westbrook Youth & Family Services

1163 Boston Post Rd, Westbrook CT         

Speakers from throughout CT will present on topics including:

Licensure  *      Private practice  *     Insurance  *      Marketing

MFTs in schools  *    Internal Family Systems Therapy

For questions or comments,  please contact:

Julie Iwanicki, Student Representative         JewLs1237@aol.com              

Marcie Mauro, Student Committee       MarcieMauro@yahoo.com

Minorities and Dementia

For those who need further evidence of the disparities among minorities when it comes to health care, please read the following link …

http://www.cnn.com/2010/HEALTH/03/09/alzheimer.minorities.hispanics/index.html

Diversity and CTAMFT

The following post is the first in a series of posts on the CTAMFT blog that addresses the CTAMFT’s efforts to add diversity initiatives to their strategic plan and some of the challenges that arise as part of that process. Please go to www.ctamft.org to read the other posts related to this topic…

I wanted to use this opportunity to comment on some of the discussion during and following the board meeting on the issue of diversifying our profession not only in terms of the membership but in terms of the ways and the venues in which we provide our services. 

I would like to voice my individual opinion on the issue of how we as a board can most effectively tackle the issue of diversity in our profession or at least in our state. My sense is that everyone on the board cares very much about this issue but that there is a healthy amount of fear and trepidation about how to address and discuss this issue in a politically correct way or in such a way that no one is offended or comes off looking insensitive to issues of race.

In my opinion political correctness has no place in this process as it keeps people from speaking honestly and from asking questions. Race/diversity is a sticky topic and creates a lot of discomfort and that’s ok. As a board we will continue to go nowhere if we are unwilling to be uncomfortable when discussing this issue. The discussion on shifting agencies to more systemic thinking and the notion of “dumbing down” our profession in my view is evidence of a lack of awareness about 1) the assumptions that are embedded in such a statement and 2) what is truly required to diversify our field.
 
If as a profession we decide that we want to stay 100% true to our origins and remain a specialized group of clinicians that work privately with wealthy or commercially insured (which is the same thing) clients and are ok to shrink in our numbers rather than expand our philosophical foundation; fine. If however, we as a profession wish to grow and be more reflective of our society, where in less than 20 years White people in this country will no longer be the majority; we need to be willing to have a frank discussion about these often difficult issues and table our individual anxieties and fears until we have an action plan in place.
 
I will personally mix the martinis after the meeting for those of us who need to exhale and let off some steam afterwards!
 
I would also add that this is a class issue as well as a diversity issue. There are plenty of ethnic minorities that are middle class; especially in Fairfield county and throughout our state. They are not the client population that we’re talking about. However in terms of diversifying our ranks it should be noted that middle class ethnically diverse applicants to our programs are typically not more than one or two generations removed from a lower social class and likely have extended family members that have not asended to their social class. Many of these new colleagues will be interested primarily in working in settings where they can impact the lives of people in their communities; which means agencies, hospitals etc. This issue touches many of the other things that are part of our strategic planning such as how our members can better support themselves financially in our field, identifying better career paths within agencies, hospitals and other institutions etc.
 
In short, there is much work to do here and I just hope that going forward we can have more frank and open discussion about the underlying attitudes that have made mft’s on a national as well as state level impotent in the area of diversity throughout the profession’s history. I feel confident that we can then come up with a plan that will put us our desired path. I encourage you all to blog about your thoughts or feelings about this or any other topic. Blog posts do not have to be warm and fuzzy, cold and prickly works too! In any scenario candor is ideal.

Kristen Orakwue is a CTAMFT board member, a clinician at FSW, Inc, in Bridgeport and is in private practice with the Collaborative Counseling Group inTrumbull, CT. She is also the administrtor of this blog.

Searching for a Clinical Position- Searching

The day after I posted my last blog, I got a phone call from a friend from school.  “There is a position at my job, I already told the clinical Director about you” she said.   I didn’t even remember telling her that I was looking!  This is what networking is about, letting other people help you in your search.  It works.  So keep it up.  Tell everyone you know!   In addition, try making new connections, reach out and introduce yourself to new people. 

So lets network more indirectly with the internet and search for company advertisements for open positions.   You can begin your search broadly to see what is out in the market or a more narrow focus if you know an exact direction you would like your career to take, for example “only hospitals”.  Taking a broad view here are a bunch of sites that are some of my favorites:

 www.careerbuilders.com

www.monster.com

www.fairfieldcountyjobs.com

www.westchestercountyjobs.com

www.ihiresocialservices.com

www.das.gov

www.yahoo.hotjobs.com

www.craigslist.com

www.aamft.org 

www.indeed.com

There are many titles to search try “clinician, family therapist, therapist, social worker, marriage and family therapist”.  At most sites you can search, set up email alerts to let you know of recent postings and in some places post your resume for employers can search you.   I have alerts coming to my email all the time, even when I am not looking I like to know which employers are hiring.

Lets say you know a particular place you want to work, go directly to that site.  Figure out the management team, see if you know anyone that works there and search for a way to make an introduction through a connection.  Even without a connection still apply.  Most emails are on the website.  Even if they aren’t looking now they may be later or they haven’t advertised yet and you resume came across someone’s desk. 

You recall in my first post, your resume and cover letter may get a 30 second look. When you apply for a position you are thinking of the reader.  You want to make it as easy as possible for them.  If the advertisement states we are looking for X, Y and Z.  Don’t let them try to figure out how you qualify.  In your cover letter you state, here is how X, Y and Z are presented in my resume.  Remember your cover letter is the first impression the company has of you, make it a good professional one.

Reach out to me at the email below with questions/comments or wanting to make in introduction!

Susan E. Kotulsky graduated Fairfield’s MFT program in May 2009 and is currently working per diem for Horizon’s in Bridgeport, CT.  Horizon’s is an inpatient substance abuse facility for individuals with a primary diagnosis of substance dependence.  She is also an HR Consultant and worked in the Human Resources profession for 20 years.  She can be reached at susankotulsky@aol.com.