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In this last discussion, carefully reflect upon the chapter readings, content gu
In this last discussion, carefully reflect upon the chapter readings, content guides, discussions, quizzes, videos, the assignment, and intervention models. Write and submit a short essay post of about 250 to 400 words and address all of the following steps:
Describe your personal major learning points (aka “learning take-aways”) from this course. Include all significant concepts, learning points, insights and realizations about families, family dynamics, systems theory, family development cycles, intervention models, how working with families differs from individual methods, etc.
Which concepts, models and theories about family intervention did you find especially of value?
Are there mistaken beliefs and misconceptions you once held about families and family interventions that have changed as a result of this course? Please describe what you originally thought and what has changed for you?
How might you continue to apply what you have learned in future courses?
Specifically, how might you apply your new knowledge in your work and/or personal life?
An interesting fact is that family therapy evolved out of research in which family interactions were observed, especially families with members who had a serious mental disorder or substance use disorder. Family interaction research was conducted at the Mental Research Institute in Palo Alto, California in the late 1950s led by anthropologist Gregory Bateson, with clinical practitioners Virginia Satir, John Weakland, Don Jackson, Jay Haley, and Paul Watzlawick. Peter Steinglass and his associates (1987) conducted studies observing families who had an alcohol dependent member while at George Washington University in Washington, DC. Murray Bowen at Georgetown University observed families within an inpatient setting who had a member who had schizophrenia. Others, including Wynne (1988), Boszormenyi-Nagy and Framo (1985) and Lidz and Lidz (1949) were psychiatrists or psychologists who initially began doing research with families with members affected by schizophrenia. Only later did the above researchers therapeutic methods.
The focus of these many family researchers ultimately shifted to developing family therapy models and family interventions, but left behind the importance of researching the methods. This led to diverse ideas and theoretical concepts, at the expense of scientific research that did not rigorously test these theories and strategies that could explain family processes and facilitate therapeutic change. Such research testing was essential for verifying the efficacy and safety of various family interventions, yet was overlooked for some years.
As the marital and family therapy field has evolved, research and research coursework has been integrated as a requirement of graduate social work, mental health and family therapy programs. Research about family therapy and theory now continues to expand due to the scholarly work of faculty teaching in graduate programs. Research using the scientific method is now a foundation of all family therapy theory and the practices that are developed. A “good theory” is important as it can explain family dynamics, it can make useful and specific predictions, it can support which methods work best for certain populations, the theory can be tested scientifically, and its utility will be supported by ongoing research by independent researchers. Over time, a good theory will evolve as new information is gained from research and practice. However, too often the importance of research has gotten lost and many practitioners dismiss its significance and relevance to their own practice, thinking they know best what to do.
Family interventions and counseling in any form (individual, group, family) should never be practiced based on conjecture, speculation, one’s own personal experience, or based on clinical intuition- “it felt like the right thing to do”. Sound clinical practice must be based on well-grounded theory that has been scientifically validated or at least has evolving scientific support from quality clinical research. Practitioners also need to be able to articulate any theoretical model with which they are using and be able to explain what they are doing and why they are doing it. They also must know the limits of a model, draw on clinical expertise, client feedback, and recognize when their chosen methods are not effective.
Presently, Evidence-Based Treatment (EBT) models are prioritized in therapy. These are models that have been validated and popularized by randomly-controlled trials (RCTs). RCTs are studies in which individuals receive an experimental treatment are compared with a control group- those receiving no treatment or who receive some commonly used “standard treatment”. The experimental treatment follows a specific protocol which is usually manual-ized (uses step-by-step instructions for implementation) so interventions are delivered consistently across populations, settings, and practitioners. When the experimental group shows a statistically significant response to the treatment as compared to the control group, the treatment is considered to be “evidence-based.”
Another research approach is the use of Case Studies that provide an in-depth examination of one or a few family intervention cases where a specific theory and method was used. While this can be a useful starting point to explore a given intervention method, it has many limitations due to the lack of control for variables that affect each case. Without controlling for these variables, it isn’t possible to identify a direct cause-effect relationship between the intervention and outcomes.
Cohort studies use a select group of families with similar characteristics to explore whether the approach consistently shows effectiveness in family participation, retention, and change, compared to another group where these methods are not used.
Correlation studies are often used to identify whether a systematic and strong relationship exists between two or more variables that improve therapeutic outcome of families. Two examples of a correlation study are:
-better outcomes for families who attend psycho-educational groups along with family intervention sessions compared to for those who do not.
-increased abstinence rates for clients who are engaged in individual and family sessions vs those only attending individual and group therapy.
For those who plan a career in human services, it is important to gain understanding of basic statistics and basics of doing social science research, so that one can at least read and develop some basic analysis of family intervention research. Gathering feedback from families and clients as to what was helpful and what was not helpful should also not be under-estimated as to its importance to assess your own effectiveness. This will help you learn to self evaluate your own practice.
References:
Boszormenyi-Nagy, I., & Framo, J. (Eds.) (1985). Intensive family therapy: Theoretical and practical aspects. 2nd Edition Brunner/Mazel
Lidz, R.W. & Lidz, T. (1949). “The family environment of schizophrenic patients”, American Journal of Psychiatry, Vol. 106, 1949, pp. 332–345.
Mental Research Institute. ( n.d.) About MRI. https://mri.org/about
Steinglass, P., Bennett, L.A., Wolin, S.J. & Reiss, D. (1987). The Alcoholic Family. Basic Books
Wynne L.C., Ryckoff L.M., Day J. & Hirsch, S. I. (1958): Pseudomutuality in the family relations
of schizophrenics. Psychiatry, 21:205-220
Wynne, L. (Ed.) (1988). The State of the Art in Family Therapy Research : Controversies and Recommendations. Family Process Press.
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