Environmentally-constructed, regional culture as defined by geographic place is not generally included in family therapy research and training concerning race, ethnicity, gender, sexual orientation, and other contextual factors. This grounded theory research project explores how practitioners working with families acknowledge, access, and use region as a cultural context in their service delivery, specifically in the New River Valley region of Southwest Virginia. Ecological theory, social construction theory, family systems theory, and cultural competency perspectives were used to frame the research questions, to develop the interview protocol, and to support the analysis of the properties and dimensions of the concepts and categories that emerged from the data analysis. The resulting grounded theory revealed that clinicians working with regionally distinct clients combine a client-centered approach with multiple-layers of regional knowledge and self-awareness. / Ph. D.

In recent decades there has been an increase in literature regarding sexual addiction as well as a growing number of clients presenting in therapy with problems related to their sexual behaviors (including internet sexual addiction). More recently, the impact of sexual addiction on couples has been noted, but little is known regarding how couples can be assisted in the recovery process. In this qualitative study, I explored in depth the critical change processes in couple therapy for sexual addiction from the therapist's perspective, including the therapist's role in that process. The findings suggest that couple recovery from sexual addiction includes (a) individual responsibility in recovery (which includes themes of trauma, family-of-origin, emotional reactivity, depersonalizing, and utilizing other resources), (b) couple recovery (which includes the themes of family-of-origin, communication, empathy, intimacy, trust, and sexual intimacy), (c) balancing individual recovery with couple recovery in the process of healing (which includes the themes of education, accountability, and couple perspective) and (d) distinguishing affairs from sexual addiction. I discuss the implications of study findings, offering a sequential outline of the process of therapy with couples who are struggling to recover from sexual addiction, including therapist interventions that may assist in that process. Limitations to the study and implications for future research in sexual addiction generally and MFT specifically are presented. / Ph. D.

Systemic thought has been utilized to deconstruct various works of literature and art, such as novels, plays, and even sculptures. Even though the Bible is viewed as a work of faith by many, it also combines aspects of mythology and history with prose and poetry. Using four major theories of family therapy, namely structural, contextual, Bowenian, and narrative, the family of King David, as presented in the first and second Books of Samuel and the beginning of the first Book of Kings, is investigated and explored. Using the King James Version of the Bible as the main text, consideration is given to what each theory has to offer in expalining what occurs throughout this narrative, as well as what the David story has to say about each theory. Confirmation of certain aspects of a given theory and possible refinements to these are also given consideration. Reflexivity on the part of the author is also given consideration in the final chapter. / Ph. D.

In the past decade the push for utilization of evidence-based practice (EBP) in mental health has increased dramatically. Due to managed healthcare, lowered spending on state and federal mental health budgets, and requirements by funding agencies such as Medicaid, it is imperative that mental health clinicians (MHCs) be trained in and utilize EBPs to improve funding and ensure continuity of best practice in clinical interventions with clients. Minimal research exists on MHCs and their knowledge and use of EBPs. The present study examined MHCs' perceptions, knowledge, training, and utilization of EBPs, with a specific focus on Dialectical Behavior Therapy (DBT). To date, it is the most prominent and effective EBP for treating Borderline Personality Disorder (BPD) and associated parasuicidal and suicidal behaviors. Current research supports its effectiveness in treating a myriad of other commonly treated disorders. The exploratory study provides insight into MHCs level of interest in receiving more EBP awareness and DBT training. Results indicate that though clinicians have received training in EBP and DBT, most of that training has been encouraged through career settings. Age of the clinician, years in practice, and type of training background are predictors of level of education, knowledge and training. Results show the majority of clinicians are interested in EBP, aware of the impact EBP can have on treatment effects, and report desire to have more training in EBPs and DBT specifically. These results could provide a necessary bridge between disciplines to allow clinicians, irrespective of training, to provide the most clinically effective treatments to clients. / Ph. D.

Bilateral art is a neurologically-based therapeutic intervention that engages both dominant and non-dominant hands in the creation of images in response to polarized beliefs, cognitions, or feelings. Advances in neuroscience that integrate attachment theory and experience with neuronal development argue for use of the intervention. Retrospective case studies using enhancements of the bilateral art intervention protocol for individuals support these arguments. These case studies demonstrate clinical application of the intervention to a range of presenting problems including differentiation from family of origin, parenting problems, loss, trauma, and self-esteem concerns and provide the first documented evidence of the effectiveness of the bilateral art intervention. Additional case studies reflect development of two different bilateral art intervention protocols that facilitate exploration of relationships. The first protocol adapts the use of bilateral art with individuals to use with couples and it has a dual purpose: to facilitate both openness and integration of polarized thoughts or feelings in one member of a couple and to increase empathy in the other. The second protocol facilitates exploration of and reflection upon a relationship and is applied in the case study to the supervisor-supervisee dyad that is an integral part of the training of marriage and family therapists. Experiences reveal possible contraindications as well as indications for the use of these protocols. / Ph. D.

Little has been published regarding the experiences of seasoned MFTs who not only manage to survive the demands and pressures in the mental health field, but also thrive and find enjoyment in their work. This qualitative study, guided by a phenomenological perspective, provides a rich understanding of the experiences of seasoned MFTs who continue to remain joyous and passionate in their work. Six female peer-nominated therapists, with at least 15 years of clinical experience, from the Washington D.C. Metropolitan area participated in semi-structured interviews. Results from the interviews are organized around six themes: Portrait of passionate seasoned therapist; getting renewed by clinical work; managing spillover; sustaining balance; changing commitment to the profession; and advice to novice therapists. The findings are both consistent with, and add to the literature indicating that accumulated experience is a major resource for therapists and sustaining balance through the use of various self-care strategies is vital. Limitations, suggestions for future research, and implications of this study also discussed. / Master of Science

Doctor of Philosophy / Department of Family Studies and Human Services / Joyce Baptist / The purpose of the current study is to examine what factors contribute to how marriage and family therapy (MFT) programs address multicultural competency training and to understand the support mechanisms of the training process. A sequential explanatory mixed-method design was utilized to evaluate MFT training programs. First, a Multicultural Survey, adapted from the Multicultural Competency Checklist (Ponterotto, Alexander, & Griegor, 1995), was used to gain a preliminary understanding of the masters MFT field regarding multitcultural competency training. Out of the 70 MFT program directors contacted, 39 program directors or program representatives responded to the survey (55.71% response). Qualitative interviews from 8 participants (program directors, n = 7; program representative, n = 1) representing each geographical region (Northeast, n = 2; South, n = 2; Midwest, n = 2; West, n = 2) were used to examine programs’ multicultural competency training content, program context and training processes. Five themes emerged from the data: 1) internal program dynamic, 2) external program factors, 3) stakeholders, 4) faculty recruitment, and 5) cross-program collaboration. General systems theory, process theory and the logic model were utilized to conceptualize the results (Kellogg, 2004; Rossi, Lipsey, & Freeman, 2004; White & Klein, 2002).

Doctor of Philosophy / Department of Family Studies and Human Services / Sandra Stith / Recent years have seen a rise in the medicalization of treatments for erectile dysfunction (ED). While there has been a divide between the medical and psychological communities, some have called for a more collaborative relationship. Little research has been done on the collaboration between medical professionals and psychotherapists in treating ED. This study seeks to increase current knowledge about medical professionals’ referral practices and communication post-referral. An online survey was developed and distributed to the members of the Sexual Medicine Society of North America (SMSNA) (N = 541). Survey questions inquired as to the factors that increased participants’ willingness to refer ED patients, the form of communication participants currently desire to have with psychotherapists and the participants’ desired level of communication with psychotherapists to whom they might refer. Less than ten percent of the medical professionals invited to participate in the study completed the survey (n=50). Those who did complete the survey were primarily male, specialized in urology and practiced in the U.S. Almost half the respondents were employed in an academic setting while just over half of respondents worked in hospital-based, group, or solo practices. Just over half of the survey participants practiced in urban areas. Although the number of medical professionals who completed the survey was small, findings indicated that those who completed a sexual medicine fellowship and who had a larger percentage of their patient population being seen for ED were more likely to refer patients to psychotherapists. Participants who have referred ED patients to psychotherapists reported little-to-no communication between them and the psychotherapists to whom they refer. The study participants expressed a desire to refer patients to psychotherapists who are experienced in working with both sexual and couples issues. Questions about the desires and experiences of medical professionals who have not referred to psychotherapists were not able to be answered because of the limited number of these individuals in the data set. Although the number of participants who completed the survey limits the generalizability of the data, this study demonstrates that most medical professionals who responded to the survey are willing to refer ED patients to psychotherapists.

The current study investigated how three distinct types of childhood abuse—witnessing of parental domestic violence, experiencing physical abuse and total in-home violence, and experiencing sexual abuse—predicted partner reports of relational violence through the mediating factors self-perceptions of attachment and partner reports of relational aggression. The study used paired dyadic data from 1,658 couples who had completed the RELATionship Evaluation (RELATE). The Family Violence, the Brief Accessibility and Responsiveness, Couples Relational Aggression and Victimization, and the Conflict Tactics scales were the measures used. Data was analyzed by using structural equation modeling to estimate an actor-partner interdependence model exploring these relationships. Results showed only female childhood sexual abuse had direct associations with male relational violence; however, several mediating paths were identified.

The purpose of this study was to investigate the relationship between relational aggression and sexual satisfaction, as well as the mediating role of attachment on this relationship. Data came from the Relationship Evaluation Survey (RELATE) comprised of the matched-pair responses of 797 couples in serious dating, engaged, or married relationships. Results showed the greater the perceived relational aggression the lower the sexual satisfaction for both self and partner, regardless of gender. Additionally, it appears a more satisfying sexual relationship can occur when an individual experiences a secure attachment base and can feel confident that his/her relationship is safe. For both genders, the more relationally aggressive behaviors reported, the lower the reports of secure attachment behaviors. Implications for clinicians and future research are discussed.