This study discusses the intergenerational impact of mass incarceration on families. The general literature repeatedly described the negative effects of mass incarceration among children who have an incarcerated parent by pointing to the difficulty of educational attainment, social exclusion, stigma, substance abuse, and the exacerbation of mental health issues such as depression, anxiety, and antisocial behavior (Kjellstrand & Eddy, 2011; Miller & Barnes, 2015; Turney, 2014). Unfortunately, most incarcerated individuals are parents and most incarcerated women are mothers (Scudder, A., et al., 2014, and Miller, et al., 2014). Through the use of art, service providers (artists, clinicians, etc.) that facilitate parent based programs in correctional facilities or re-entry programs can alleviate the trauma caused by incarceration that affect the emotional and mental well-being of families. Two organizations that provide art programs to incarcerated parents participated in a qualitative study about the effective use of art in their programs. Themes from the interviews discussed the value of cultural humility, as well as the role of social justice and restorative justice frameworks when providing art-based programs for parents. The lack of trust, compassion, and empathy were barriers in the process of delivering services to families. Since the creative process is inherently inclusive and actively engages its participants (e.g., therapists, patients, observers), the results of this study point to art creation as a vehicle that promotes trusts and supports family relationship restoration in order to intercept the cycles of intergenerational trauma.

This qualitative case study explores the long-term effects of domestic violence through the lens of art therapy treatment. The study is based on a twelve-week long art therapy treatment group for women who have experienced domestic violence. The study includes a literature review and a qualitative analysis of the participants’ artwork and details of their experiences of domestic violence related trauma. The research focuses on two participants and utilizes textual and visual analysis to identify four emergent themes: Family and identity, hope in moving forward, support and connection, and freedom. The findings discuss the value of art therapy in revealing coping skills, strengths and internalized fears related to domestic violence trauma. The women in the study illuminate an increase in awareness of internal resources and hopeful narratives for healing. The study demonstrates the potential of art therapy to make visible the long-term effect of domestic violence, and assist in the treatment of survivors.

Despite negative perceptions of therapy, Black Americans are seeking therapy. I interviewed 8 Black clients about their experience of MFT. I used the Multidimensional Inventory of Black Identity (MIBI; Sellers, Rowley, Chavous, Shelton, & Smith, 1997) to assess their racial identity. Most participants thought it was strange for Blacks to seek therapy. Yet, these participants found the strength to seek therapy to protect their family and individual well-being. Participants found support from family, friends, and/or the church/religious beliefs. All attended church but few sought their pastor for therapeutic support. The participants who initially preferred a Black therapist also strongly viewed race as central to their self-identity. However, participants expressed greater concern for therapist competence, skills, and warmth than for therapist race. Yet, many discussed the benefits of having a Black therapist, which were greater comfort, ease, and openness for Black clients in therapy, as well as greater cultural familiarity for Black therapists. All of the participants reported satisfaction with their therapist and generally reported a positive experience. I also measured the experience of the first and third therapy sessions for Black and White clients, using the Session Evaluation Questionnaire (SEQ; Stiles, 2000). Black clients reported significantly less depth in the first session than White clients, suggesting a unique experience of therapy for Black clients. Also, Black clients that remained in therapy reported less smoothness in the first session than those who terminated. There were no significant findings for the third session. Research and treatment implications from these findings are discussed. / Master of Science

A strong therapeutic alliance is consistently related to successful outcomes in couple therapy. However, most of the research done on therapeutic alliance has been done among non-Latino White individuals and couples, failing to account for other ethnic minorities like Latinos. Latinos tend to share certain commonalities as opposed to non-Latino clients that may alter the relationship between alliance quality and relationship quality. This exploratory study was designed to understand whether Latino clients have higher initial levels of alliance and a stronger alliance-outcome relationship in couple therapy when compared to non-Latino White couples. The sample consisted of 567 couples seeking therapy to improve their relationship (99 Latino and 468 non-Latino White couples). A multigroup moderation model was used to test whether Latino ethnicity moderates the association between alliance quality at session four and relationship quality at the final session. Similar findings of the association previously established between alliance quality and relationship quality were found. Results indicated that there was no statistically significant difference between Latinos and non-Latino Whites on initial levels of alliance quality nor on the relationship between alliance quality and relationship quality.

More than 40 million American adults suffer from anxiety, but only a third receive care despite evidence of effective treatment. This is attributed to lack of access to adequate services, cultural-based myths, and prohibitive symptoms associated with anxiety, especially for marginalized populations such as racial minorities. Since spirituality is often used as a coping mechanism especially for racial groups, psychotherapy has slowly begun incorporating it into treatment. While this has the potential to reduce some barriers to care, the increasing number of Americans who are disaffiliating with traditional faiths or belong to minority spiritualities may not use the same coping mechanisms. The current study sought to contribute to the literature by obtaining a better understanding of whether the use of traditional spiritual activities and perceptions of God are different for spiritual majorities and minorities especially in managing anxiety. Using a nationally representative sample of U.S. adults (n=1525) from the Baylor Religion Study, structural equation models were tested to examine the relationships between anxiety and religious beliefs related to attachment to God as well as between anxiety and spiritual activities that encompass both social, organizational and private, subjective religiosity. Minority stress and attachment theories guided hypotheses that higher levels of anxiety would be associated with status as a spiritual minority but would be positively mediated by participation in spiritual activities such as worship services, prayer and scripture reading as well as mediated by more secure attachment to God. Results indicated that unlike spiritual majorities, spiritual minorities show lower anxiety levels compared with spiritual majorities unless using traditional forms of spiritual activities. Rather than positive or negative perceptions of the relationship with God, inconsistent perceptions were associated with higher levels of anxiety for all participants. Spiritual minorities had lower levels of both positive and negative perceptions of God's persona as well as lower levels of positive perceptions of the relationship with God, none of which correlated to anxiety. The results may indicate that spiritual minorities use other activities to successfully cope with anxiety and that they have greater anxiety when trying to conform to the dominant culture. This has important implications for practice given that many therapists lack training on how to incorporate spirituality into treatment. Distinctions between perceptions of the relationship with God and of God's persona indicate the need for further study of how more nuanced spiritual beliefs influence anxiety outcomes for a diverse range of spiritual practice and of the process by which individuals intentionally use spiritual tools to cope with anxiety. / Ph. D. / More than 40 million American adults suffer from the debilitating impact of anxiety through persistent worrying, obsessive thoughts, fear of social situations, compulsions, and paranoia. Only a third receive care despite effective treatment options because of such disruptive symptoms in addition to a lack of insurance, racial disparities, cultural myths, and concerns that their beliefs will not be valued. This limits access to care especially for those who need it the most, including racial minority groups. Since many Americans use spirituality as a coping mechanism to combat anxiety, psychotherapy has begun incorporating aspects of it. While this could reduce some barriers to care, it is not known whether the increasing number of Americans who are disaffiliating with traditional faiths or belong to minority spiritualities use these same aspects to cope. This study sought to understand whether the use of traditional spiritual activities and perceptions of God are different for spiritual majorities and minorities especially in managing anxiety. Using a nationally representative sample of 1,525 U.S. adults from the Baylor Religion Study, the study examined the relationship between anxiety and spiritual activities such as frequency of attendance at worship services and private prayer and scripture reading. The study also examined how attachment to God through perceptions of the relationship with God and of God’s persona might be associated with spiritual minorities and their anxiety levels. Results show that unlike spiritual majorities, spiritual minorities have less anxiety unless using traditional forms of spiritual activities. This could indicate that they use other activities to successfully cope with anxiety and that they have greater anxiety when trying to conform to the dominant culture. Rather than positive or negative perceptions of the relationship with God, inconsistent perceptions were related to higher levels of anxiety for all participants. Spiritual minorities were more moderate in their attachment to God, with less positive and negative perceptions of God’s persona and less positive perceptions of their relationship with God. However, none of spiritual minorities’ perceptions did not have a significant relationship with their anxiety levels. The study’s results show a need to explore further how a more diverse range of spiritual beliefs influence anxiety and the process by which people intentionally use spiritual tools to cope with their anxiety. Guidance for how therapists can increase their spiritual competence is discussed.

The Merriam-Webster Dictionary (2018) defines heartbreak as “crushing grief, anguish or distress.” Heartbreak can lead to biological, psychological and social responses and consequences. Heartbreak from the dissolution of a romantic relationship is a form of disenfranchised grief, which is defined as the griever’s belief that society does not recognize their source of grief as legitimate (Doka, 1989). The literature shows that talking about grief helps those who experience it (Fisher & Archer, 2008). Hence, the present study sought to provide a consensus of the best practices that marriage and family therapists have utilized to help broken-hearted clients. I employed a modification of the Delphi technique, a research method which seeks to reach consensus on a topic through group communication between experts in the subject area discussed (Hsu & Sandford, 2007) in order to gather data about best practices from marriage and family therapists on how they have helped their broken-hearted clients. This study consisted of a total of 20 experts, who are licensed marriage and family therapists. The findings suggest that the disenfranchisement of the grief resulting from the dissolution of a romantic relationship is closely associated with the symptom of sadness experienced by the broken-hearted. In addition, the way in which MFTs can help the disenfranchised griever is by providing an empathic presence in sessions, generating historical conversations through the use of a genogram, involving family members in the therapeutic process and having future oriented conversations. The results of this study have illustrated a plethora of techniques and best practices that have reportedly proven successful in helping the broken-hearted client.

In-home family therapy has become one of the most common options of treatment for providing services to families who do not typically utilize a private clinic (Lawson, 2005; Reiter, 2000; Yorgason, McWey, & Felts, 2005). Researchers have given some attention to the topic of home-based therapy and to general supervision, but little attention has focused on the actual supervision experiences of home-based therapy providers. This phenomenological study explored the supervision experiences of seven past and current in-home therapists: marriage and family therapists (MFTs) and social workers (MSWs). Semi-structured interviews were conducted with the participants, and data was analyzed to develop structured descriptions and meanings via highlighted “significant statements” that described the participants’ experiences (Kvale, 2007). The participants’ descriptive accounts were categorized as 1) in-home therapy descriptions, 2) factors affecting in-home therapy supervision, and 3) effective and ineffective supervisory practices. Implications of the research findings suggested that clinicians’ needs and expectations related to safety, burn out, and supervisory knowledge were often unmet. Supervisory practices that appeared significantly effective were 1) developing trusting supervisor-supervisee relationships, 2) reviewing models and clinical application collaboratively, and 3) actively prioritizing clinician safety and burn out prevention.

The client-therapist relationship is an essential part of therapy and is central in helping clients achieve therapeutic goals as the joining process facilitates the change process. However, in an effort to create a space for change, there is a possibility that professional boundaries may become blurred wherein a client may express a sexual attraction toward their therapist. To explore this phenomenon, the researcher employed convergent parallel mixed method design to explore the experiences of Licensed Marriage and Family Therapists (LMFTs) who have experienced sexual attraction from their clients. The study was conducted online through a secure forum. Implications for clients, therapists, and the field of marriage and family therapy are discussed. The research suggests that education and training are critical in assisting therapists when dealing with sexual attraction issues.

The positive psychotherapy focused on for this study is Solution-Focused Brief Therapy (SFBT). Insoo Kim Berg and Yvonne Dolan (2001) once described the essence of Solution-Focused Brief Therapy (SFBT) as the “pragmatics of hope and respect” (p. 1) and despite Berg and Dolan’s declaration of hope’s importance in SFBT, little process research has been published looking at the “pragmatics” of hope in SFBT practice. Hope is seen as a common factor in psychotherapy since the human relationship, also known as the therapeutic alliance, is a foundation of psychotherapy. Hope plays a significant role in every human interaction and it is seen as a common factor in human relationships. To begin to address this gap, a pilot study was conducted of an Insoo Kim Berg training recording, Irreconcilable Differences, in order to explore how she listened, selected and built hope in her work. Based on a SFBT technique focus, the preliminary results suggested Insoo Kim Berg builds hope relationally through the solution-building by working within the clients’ focus and their presenting problem. Four different yet interrelated hope phases in the SFBT solution building process were identified. To address this gap further, based on a SFBT stage focus, three cases by Insoo Kim Berg were analyzed in this study, Irreconcilable Differences, Over the Hump, and I’d Hear Laughter. The goal of this research was to demonstrate the how Berg listened, selected, and built hope with clients to validate her progression within and across the five SFBT solution-building stages, in all three cases through constant comparison, and to show how these findings are congruent with SFBT hopeful tenets. All with the intention of allowing the pragmatics of hope and respect to become more transparent for future SFBT practitioners. Findings suggested building hope appears to be a relational process to building solutions and is co-constructed. Berg demonstrates how she embodies a hopeful stance throughout the duration of therapy. Results show how Berg builds hope within and across her progression of the solution-focused brief therapy solution-building stages, utilizing SFBT techniques and processes, which all align with the foundational SFBT tenets.

A review of the research related to Medical Family Therapy demonstrates that the inclusion of marriage and family therapists as part of the healthcare team offers benefits such as decreased utilization of healthcare, decreased costs, increased positive outcomes for patients and healthcare systems. However, studies demonstrate the difficulty with communication between providers limiting access to marriage and family therapists. Results of this study identified benefits to working with medical family therapists including broadening the understanding and using a collaborative effort to help the patient improve and get better. Participants also identified barriers to collaboration such as the lack of knowledge of and access to MedFTs, their inclusion in the system, MDs finding value in the MedFT profession, and that the communication process is lacking. Further need for improved communication at the referral and follow-up stages in collaborative practices is shown. In order to move more toward collaborative practices, PCPs and MedFTs need to develop and disseminate training on treatment notes, communication, team meetings, and continuance of collaborative work with one another.