A randomized controlled trial examining general parenting training and family-based behavioral treatment for childhood obesity: The ReFRESH study design.

Family-based behavioral treatment (FBT) is one of the most effective treatments for childhood obesity. These programs include behavior change strategies and basic parenting training to help parents make healthy diet and physical activity changes for their children. While effective, not all families respond to this program. Additional training on how to effectively deliver these behavior change strategies may improve outcomes. The authoritative parenting style is associated with many positive academic and socio-emotional outcomes in children, and is characterized by displays of warmth and support while also being consistent with setting limits and boundaries. This parenting style has also been associated with normal weight status. Furthermore, parenting training programs that promote this parenting style for children with behavioral issues have shown unintended effects on decreasing child weight status. Therefore, our goal was to examine the effect of adding more intensive parenting training to FBT on child weight status. We randomized 140 children and their parent to either FBT or FBT + Parenting Training (FBT + PT). Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12), and 12-month follow-up (month 18). Primary outcome was change in child weight status. Secondary outcomes were rates of drop-out, treatment adherence, and acceptability. If effective, this program may provide another alternative for families to help improve outcomes in childhood obesity management.

Cultural competence in multi-family psychoeducation groups: The experiences of Russian-speaking immigrant mothers of adults with severe mental illness.

The successful integration of cultural competence with evidence-based practices in mental health services is still limited for particular cultural populations. The current study explored culturally adapted family psychoeducation intervention for immigrants from the former Soviet Union (FSU) in Israel who care for a family member with severe mental illness (SMI). Semi-structured in-depth interviews were conducted with 18 immigrant mothers about their experience of taking part in Russian-speaking multi-family psychoeducation groups (MFPGs). Qualitative content analysis revealed five salient processes and changes that participants attributed to their engagement in the intervention: 1) from a language barrier to utilization of and satisfaction with services; 2) from a lack of information to acquiring new mental health knowledge; 3) from harboring a family secret to exposure and sharing; 4) from social isolation to cultural belonging and support; 5) from families blurring boundaries to physical and emotional separation. The results showed that these changes-linguistic, cognitive, emotional, socio-cultural and relational-improved family coping and recovery. Implications for cultural adaptation of family psychoeducation for Russian-speaking immigrants are discussed.

A primer on sleep for MFTs: Implications and practical considerations.

Despite many marriage and family therapists (MFTs) utilizing the Biopsychosocial-Spiritual (BPSS) framework in assessment and treatment, there is still a lack of education on sleep and the implications for mental, emotional, and relational health. Newer research within many fields highlights the far-reaching spillover effects of short or poor-quality sleep that can affect our clients. MFTs need to know how to assess, how to provide proper psychoeducation, how to apply this knowledge in clinical settings, and how to collaborate with other healthcare providers. As such, the purpose of this article is threefold: (a) review the biopsychosocial-spiritual importance of sleep; (b) equip MFTs with information on sleep assessment, how to identify situations for referral, and how to provide psychoeducation on sleep hygiene; and (c) review important considerations for research and practice for MFTs.

A call to action: Online learning and distance education in the training of couple and family therapists.

Distance education in couple and family therapy (CFT) has grown in recent years; however, due to the COVID-19 pandemic, many CFT educators find themselves delivering emergency online education out of necessity and for the first time. Despite the growth of distance learning over the last decade, there is virtually no CFT scholarship on the topic. Comparable disciplines, including social work and professional counseling, are further along in researching distance learning. Outside of the counseling disciplines, there is also ample scholarship guiding the delivery of distance education. This article builds on the small body of CFT scholarship on technology in training and supervision, reviewing extant research on distance learning in social work and counselor education. Major themes in this research reveal opportunities and challenges associated with distance learning and offer guidance about ways that CFT education can evolve in order to effectively integrate technology and online learning into our educational landscape.

The transition to teletherapy in marriage and family therapy training settings during COVID-19: What do the data tell us?

In the wake of the COVID-19 pandemic, little is known about how university training programs transitioned to teletherapy. This study describes the transition of two university marriage and family therapy (i.e., master's and doctoral) training clinics to teletherapy and presents preliminary analyses of the types of clients and cases that converted to teletherapy. A series of chi-square analyses, a t-test, a logistic regression model, and a multiple linear regression model were employed. Four key findings emerged: (1) most cases converted to teletherapy; (2) Hispanic ethnicity was the only demographic characteristic to significantly predict conversion to teletherapy; (3) individual cases were significantly more likely to convert to teletherapy than relational cases; and (4) the number of prior in-person sessions attended significantly predicted conversion to teletherapy. Teletherapy conversion implications are discussed across four systemic levels: client, student trainee, supervision, and larger systems.

Integration of teaming therapy and mixed-reality simulation as remote learning modality for couple and family therapy graduate training programs.

In response to COVID-19, a couple and family therapy (CFT) graduate training program integrated a teaming therapy model with virtual technology using mixed-reality simulation software. By utilizing teaming therapy--a model with strong roots in systemic theory and practice-- combined with cutting-edge simulation technology, this distance learning modality provides distinctly relational therapy supervision and training for students at a time when their internships sites are struggling to offer remote clinical services due to the pandemic. This integrative framework offers a high degree of both realism and safety, allowing experiential learning to be appropriately scaffolded for optimum creativity and engagement in an online setting. This paper describes the conceptual, systemic basis for the learning modality, steps for implementation, benefits of the model, and the authors plan for further evaluation.

Way of being and the therapeutic pyramid: Expanding the application of a common factors meta-model.

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.

The Experiences of Couple/Marriage and Family Therapists of color: A Survey Analysis.

The family therapy literature documenting the experiences of couple/marriage and family therapists (C/MFTs) of color as a group is limited. The purpose of this study was to assess the status of C/MFTs of color in their clinical training programs, clinical work, and related areas of professional challenges and opportunities. Participants (N = 113) completed a one-time, anonymous electronic survey on SurveyMonkey consisting of demographic questions, closed- and open-ended questions about their experiences. Key findings are reported related to C/MFTs of color experiences in training programs, areas of professional need, and working with racial and/or ethnic minority clients. These findings shed light on how social justice principles and practices upheld in our field are experienced from the emic perspectives of C/MFTs of color. These voices help to broaden our understanding of how we might move forward in advocating for and advancing a more culturally responsive agenda within our profession.

Sense of coherence in systemic family therapy trainees in times of change.

This study aimed at qualitatively exploring the development of a sense of coherence (SOC) among systemic family therapist trainees (FTT) over a 3-year period. It was conducted in a private family therapy training institute in central Germany. The sample consisted of 66 trainees. The components of SOC and their general health played an important role in the development of FTTs throughout the three training years. Findings show that the SOC component of meaningfulness (motivation) was most frequently mentioned and most important to participants' personal and professional development, followed by comprehensibility (understanding of self, others and the context) and finally by manageability (coping with challenges based on personal, social and professional resources). The three SOC components fostered a positive self-care approach in FTTs and improved health and well-being over the 3 years. Visions of FTT at the end of the training show that they aim at personal and professional growth and development in the Fourth Industrial Revolution (4IR).

Behind the (Virtual) Mirror: Online Live Supervision in Couple and Family Therapy.

Online therapy and supervision, a rapidly rising practice in couple and family therapy, has been the subject of a growing body of literature. From its early days, family therapy training has included live supervision, which has typically been conducted by a supervisor and a team of trainees situated on the other side of a one-way mirror. With the outbreak of the COVID-19 global pandemic, we-the staff of supervisors at the Barcai Institute in Tel Aviv, Israel-were compelled to find solutions to continue meeting with clients and to provide supervision for family therapy trainees. To this end, we have shifted our live supervision courses ("practicums") to the virtual arena, adapting the popular application "Zoom" into what we call "PractiZoom." Based on over 100 PractiZoom sessions conducted between March and May 2020, involving 14 supervisors and 28 therapists-in-training and their clients, the article reflects on this pioneering online practicum for the online live supervision of therapists with geographically distributed participants. In this article, we outline our operational methods and adaptations for conducting live behind-the-mirror supervision online. Following a short theoretical background, we outline the process of online live supervision, discuss our reflections and those of our trainees on the challenges and possibilities it poses, and offer a number of preliminary conclusions and recommendations.

La terapia y la supervisión en línea, una práctica que está aumentando rápidamente en la terapia de pareja y familiar, ha sido tema de publicaciones crecientes. Desde sus primeros días, la capacitación en terapia familiar ha incluido la supervisión en vivo, que normalmente ha sido dirigida por un supervisor y un equipo de practicantes ubicados del otro lado de un vidrio de visión unilateral. En la medida de nuestro conocimiento, la bibliografía aún tiene que abordar la supervisión en línea en vivo que incluya una familia, un terapeuta, un supervisor y un equipo, todos en línea. Con el brote de la pandemia mundial de la COVID-19, nosotros─el personal de supervisores de Barcai Institute de Tel Aviv, Israel─nos vimos obligados a encontrar soluciones para continuar las reuniones con los pacientes y supervisar a los practicantes de terapia familiar. Con ese fin, hemos trasladado nuestros cursos de supervisión en vivo ("prácticas") al área virtual, adaptando la famosa aplicación "Zoom" a lo que nosotros llamamos "PractiZoom." Sobre la base de 100 sesiones en PractiZoom realizadas entre marzo y mayo de 2020, en las que participaron 14 supervisores y 28 terapeutas en prácticas y sus pacientes, el artículo reflexiona sobre esta práctica innovadora en línea para la supervisión en línea de terapeutas con participantes geográficamente dispersos. En este artículo, describimos nuestros métodos operativos y adaptaciones para llevar a cabo una supervisión en línea en vivo detrás del espejo. Después de un breve marco teórico, describimos el proceso de la supervisión en línea en vivo, debatimos nuestras reflexiones y las de nuestros practicantes sobre las dificultades y las posibilidades que plantea, y ofrecemos numerosas conclusiones y recomendaciones preliminares.

Sitting In: The Experience of Learning and Practicing Family Therapy through Being a Co-Therapist in Hong Kong.

This article explores family therapy trainees' subjective experiences of working as cotherapists with a supervisory-level therapist in a Chinese context, regarding their perceptions of and positioning in it and also their opinions on the benefits and/or pitfalls of cotherapy. Individual interviews with a total of six cotherapists revealed three themes: (1) Cotherapy was perceived as an experiential learning journey that evolved from anxiety and excitement to empowerment and nurturing; (2) a collaborative master-apprentice relationship of openness, trust, and mutual respect was developed with both sides' interactive effort, which included common commitment and concern for the client, the supervisor's awareness and explicit address of the role hierarchy, principle setting prior to the cooperation, and honest pre- and-postsession sharing and discussion; (3) the dual-purpose supervisor-trainee cotherapy brought direct benefits for all involved parties and for others. The findings have useful implications for integrating treatment and training for optimal training/learning outcomes and for advancing knowledge transfer from senior to junior and from academia to the field, with reference to local cultural characteristics.

Este artículo analiza las experiencias subjetivas de los practicantes de terapia familiar en su trabajo como coterapeutas con un terapeuta supervisor en un contexto chino, con respecto a sus percepciones de la coterapia y a su posicionamiento en ella, y también sus opiniones sobre los beneficios o los inconvenientes de la coterapia. Las entrevistas individuales con un total de seis coterapeutas revelaron tres temas: (1) la coterapia se percibió como un viaje de aprendizaje empírico que pasó de la ansiedad y el entusiasmo al empoderamiento y el estímulo; (2) se desarrolló una relación colaborativa de sinceridad, confianza y respeto mutuo entre el maestro y el aprendiz con el esfuerzo interactivo de ambas partes, que incluyó el compromiso común y la preocupación por el paciente, la comprensión del supervisor y el abordaje explícito de la jerarquía de roles, la fijación de principios antes de la cooperación, y el intercambio y el debate sinceros antes y después de la sesión; (3) la coterapia con doble finalidad entre el supervisor y el practicante tuvo beneficios directos para todas las partes implicadas y para los demás. Los hallazgos tienen consecuencias útiles para la integración del tratamiento y la capacitación a fin de obtener resultados óptimos a nivel de capacitación y aprendizaje, y de fomentar el traspaso de conocimiento desde los profesionales experimentados a los profesionales noveles, y desde el mundo académico al ejercicio de la profesión, con referencia a características culturales locales.

Outsider Witness Groups as a Means of Professional Growth in Family Therapy Training: An Exploratory Qualitative Study.

This exploratory qualitative study examines the experiences and meanings associated with family therapy trainees' participation in the narrative practice of Outsider Witness Groups (OWG). At the Barcai Institute in Tel Aviv, we incorporate OWGs into our live clinical supervision courses. In some sessions, we offer the families undergoing therapy the opportunity to listen to the reflections of the group of trainees regarding what they witnessed during the session. Twenty-nine family therapy trainees participated in the study in five focus group interviews. Analysis of the interviews yielded four core themes regarding the trainees' experiences: (i) Exploring the stance of the therapist; (ii) The art of listening; (iii) Reflection on hierarchy and boundary setting; and (iv) Negotiating self-disclosure. The findings indicate that family therapy trainees stand to benefit significantly in their professional journey, development, and growth from integrating OWG practices into their training. OWG fosters the development of critical reflectivity in trainees, including the deconstruction of common and taken-for-granted assumptions. It also fosters practices related to family therapy, and perhaps also to therapy in general. The findings also suggest that taking part in OWGs during training may contribute to family therapy trainees' development of critical reflectivity as a means of introducing a more critical and political approach to therapy and developing their own preferred stories as therapists.

Este estudio exploratorio cualitativo analiza las experiencias y los significados asociados con la participación de practicantes de terapia familiar en la práctica narrativa con grupos de testigos externos (OWG; White, 2007). En el Barcai Institute de Tel Aviv, incorporamos grupos de testigos externos en nuestros cursos de supervisión clínica en vivo. En algunas sesiones, ofrecemos a las familias que están en terapia la oportunidad de escuchar las reflexiones del grupo de practicantes con respecto a lo que observaron durante la sesión. Veintinueve practicantes de terapia familiar participaron en el estudio en cinco entrevistas de grupos focales. Los análisis de las entrevistas arrojaron cuatro temas principales relativos a las experiencias de los practicantes: (a) el análisis de la postura del terapeuta; (b) el arte de escuchar; (c) la reflexión sobre la jerarquía y la fijación de límites; y (d) la negociación de la autorrevelación. Los resultados indican que los practicantes de terapia familiar salen ganando considerablemente en su recorrido, desarrollo y crecimiento profesional como consecuencia de la integración de las prácticas de grupos de testigos externos en su formación. Los grupos de testigos externos fomentan el desarrollo de la reflexividad crítica en los practicantes, incluida la deconstrucción de los supuestos comunes y dados por sentado. También promueven las prácticas relacionadas con la terapia familiar, y quizá también con la terapia en general. Los resultados también sugieren que formar parte de los grupos de testigos externos durante la formación puede contribuir al desarrollo de la reflexividad crítica de los practicantes de terapia familiar como forma de incorporar un enfoque más crítico y político de la terapia y desarrollar sus propias historias preferidas como terapeutas.

The Condensed MFT Core Competencies: A Streamlined Approach for Measuring Student and Supervisee Learning Using the MFT Core Competencies.

In this article, the authors present a condensed version of the Marriage and Family Therapy Core Competencies (MFT-CC), collapsing the original 128 MFT-CC to 16 using a qualitative research method. Educators, supervisors, and researchers can more easily and efficiently use the condensed MFT-CC to measure student and supervisee learning for accreditation and training. The 16 Condensed MFT-CC are mapped to the original MFT-CC, COAMFTE's Version 12 Foundational Curriculum Areas and the Association for Marital and Family Therapy Regulatory Boards 6 domains upon which the national exam is predicated.

Measuring the Effect of Sexual Health Education Training in Professionals: Structure of the Sexual Health Education for Professionals Scale (SHEPS) Among Marriage and Family Therapy Graduate Students.

Marriage and family therapists and sexual health therapists are likely to receive training in graduate school that prepares them to encounter sexual concerns among clients, but there are few standard ways to assess the efficacy of this training. The Sexual Health Education for Professionals Scale (SHEPS) was developed to address this deficit. In this preliminary study, 163 marriage and family therapy graduate students completed the SHEPS prior to starting a graduate course in assessing and treating sexual concerns. Exploratory factor analyses indicate that the SHEPS subscales have good psychometric properties. The Skills and Knowledge subscales have factors labeled Typical Clients, Special Clients, Conservative Clients, and Ethically Complicated Clients. The Attitudes subscale had factors called General Sexual Attitudes, Valuing Sexual Health Training, Open to Providing Sexual Help, and Conservatism. This new instrument may be used to assess education and training of sexual health and marriage and family therapists. Larger sample sizes and longitudinal studies are needed in future.

The Digital Divide: Couple and Family Therapy Programs' Integration of Teletherapy Training and Education.

The mental health field is increasingly integrating and growing a teletherapy presence, and couple and family therapists are uniquely situated to offer these services based on our history of innovative approaches to therapeutic services. To do so successfully, careful consideration of training and education must occur. To evaluate current teletherapy training and education opportunities of COAMFTE accredited couple, marriage, and family therapy programs, an inductive qualitative content analysis was conducted on the responses of 95 faculty at COAMFTE accredited programs. Findings indicate that more than two thirds of the participants were in favor of teletherapy integration in training programs; however, most programs currently do not offer such opportunities. Barriers that prevent such integration were highlighted as well as existing concerns to training graduate students in teletherapy. Implications for training programs, policies, and regulations are discussed.

Impact of a Family Interventions Module on Students' Knowledge, Skills and Attitudes.

Current evidence strongly supports the implementation of family interventions as a recognised approach to working with families. The aim of this study was to evaluate postgraduate students' learning experiences and skills development whilst undertaking a Master of Science module in family interventions. Questionnaires were used to elicit students' learning and experiences in relation to their work with families. Following analysis of students' responses, the key themes that emerged in relation to family interventions included: prior learning and experiences, changes in practice, skills development, supports in practice, and course strengths and challenges. Participants particularly valued the simulated learning and reflective elements of the module. The results of the study suggest that more staff should have access to education and training to enable practitioners to work more effectively with families. However, they will need to have support mechanisms in practice to effectively implement family interventions.

Measurement Training and Feedback System for Implementation of family-based services for adolescent substance use: protocol for a cluster randomized trial of two implementation strategies.

BACKGROUND: This article describes a study protocol for testing the Measurement Training and Feedback System for Implementation (MTFS-I) and comparing two implementation strategies for MTFS-I delivery. MTFS-I is a web-based treatment quality improvement system designed to increase the delivery of evidence-based interventions for behavioral health problems in routine care settings. This version of MTFS-I focuses on family-based services (FBS) for adolescent substance use. FBS, comprising both family participation in treatment and family therapy technique use, have achieved the strongest evidence base for adolescent substance use and are a prime candidate for upgrading treatment quality in outpatient care. For FBS to fulfill their potential for widespread dissemination, FBS implementation must be bolstered by effective quality procedures that support sustainable delivery in usual care. METHODS/DESIGN: Adapted from measurement feedback systems for client outcomes, MTFS-I contains three synergistic components: (a) weekly reporter training modules to instruct therapists in reliable post-session self-reporting on FBS utilization; (b) weekly mock session videos of FBS interventions (5-8 min) for supportive training in, and practice coding of, high-quality FBS; and (c) monthly feedback reports to therapists and supervisors displaying aggregated data on therapist-reported FBS use. MTFS-I is hosted online and requires approximately 20 min per week to complete. The study will experimentally compare two well-established implementation strategies designed to foster ongoing MTFS-I usage: Core Training, consisting of two 3-h training sessions focused on FBS site mapping, selecting FBS improvement goals, and sustaining MTFS-I, followed by routine remote technical assistance; and Core + Facilitation, which boosts Core Training sessions with collaborative phone-based clinical consultation and on-site facilitation meetings for 1 year to promote FBS goal achievement. The study design is a cluster randomized trial testing Core Training versus Core + Facilitation in ten substance use treatment clinics. Study aims will compare conditions on MTFS-I uptake, FBS delivery (based on therapist-report and observational data), and 1-year client outcomes. DISCUSSION: Study contributions to implementation science and considerations of MTFS-I sustainability are discussed. TRIAL REGISTRATION: ClinicalTrials.gov NCT03342872 . Registered 10 November 2017.

The effect of family-focused psychoeducational therapy for autism spectrum disorder children's parents on parenting self-efficacy and emotion.

The purpose of this pilot study was to design, implement, and evaluate the family-focused psychoeducational therapy (FFPT) for autism spectrum disorder (ASD) family. In Phase I, 64 parents of ASD children (ASD-group) and 63 parents of typically development children (TD-group) were invited to investigate parenting self-efficacy and emotion at baseline. In Phase II, the 4-week of FFPT was offered for the ASD-group. Date was collected at baseline, post-intervention and one-month follow-up, using the parental self-efficacy, Self-Rating Anxiety Scale and Self-Rating Depression Scale. The results showed that ASD-group significantly lower levels of parenting self-efficacy and worse emotion than TD-group (p < 0.05); And after attending the program, ASD-group had significant improvements for all outcome measures and these changes maintained over a period of time (p < 0.05). This preliminary study suggests that the FFPT may effectively improve parenting self-efficacy, reduce anxiety and depression for parents of children with ASD.

Clinical and Supervisory Considerations for Transgender Therapists: Implications for Working with Clients.

Transgender therapists have unique and valuable perspectives into how gender organizes the therapeutic process. Currently, in the MFT field, there is discussion of the cisgender therapist's experience in the therapy room, but no known articles on the transgender therapist's experience. This article provides insight into the experiences of transgender therapists around issues of self-disclosure, social locations of both therapist and client, and clinical supervision. Drawing from our clinical experiences as transmen, we highlight special considerations for working with cisgender, queer, and transgender clients. Implications for supervision of transgender therapists are also discussed. As more gender diverse students seek MFT training, there is an urgent need to acknowledge their perspectives. This article is a call for beginning conversations in this direction.