Adults may acquire a hearing impairment through natural aging processes (presbycusis), exposure to loud noises, illnesses (e.g., Meniere's disease), and hereditary factors. Because hearing loss affects basic communication processes, couples often have to adjust their ways of interacting when one spouse develops a hearing loss. Extant literature presents relevant information about couple relationships in later life, individual adaptation to a hearing loss, and couple relationships where one spouse has a hearing loss. The current study was conducted to explore couple resilience processes. The family resilience theoretical framework guided this study (Ganong & Coleman, 2002; Walsh, 1996), with an emphasis on meaning that couples give to their experiences. The interaction of belief systems was explored in connection with resilience processes and the development of couple relationships. Qualitative semi-structured interviews with couples was the main method of data collection. Couples were recruited through audiologists and through a snowball sampling method. At least one partner was 60 years of age or older. Audiograms were requested from audiologists, and couples completed a marital satisfaction scale. Themes describing meaning and resilience processes emerged from interviews with eight couples in which one spouse was hearing-impaired. Themes related to meaning included couples' acceptance of the hearing loss, and demonstrations of the beliefs and values regarding their loss such as optimism, humor, gratitude, and pleasure through hearing. Couples reported having confidence in their communication skills. They also said that models of resilience, assistive listening devices, and faith in God, helped them to adapt to hearing loss stressors. Couples demonstrated healthy spousal caregiving relationships during the interviews. A focus group with marriage and family therapists (MFTs) was conducted to obtain clinical interpretations of the themes that emerged from the couple interviews. Clinicians' responses focused on couple relationship dynamics, possible clinical situations with these couples, and the therapist/client relationship. Many couples facing the hearing impairment of one spouse are living resilient lives together. However, there are likely many that are struggling. Implications for audiologists and MFTs are shared. As professionals are informed about the often unspoken and unheard stories relating to hearing loss, they can then serve with greater knowledge, empathy, and hope. / 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.

This research explored how transgender people and their partners experience the process of disclosing their gender identity, experiences of mental health, and how couple and family therapists can be helpful to relationships involving transgender people. The purpose of this study was to better understand transgender relationships to prepare couple and family therapists to work with this population. Participants were seven self-identified transgender people and three of their partners. In-depth interviews were used to explore experiences of transgender people's relationships. Nine themes were identified: decision to disclose, the road to acceptance, perceptions of sexual orientation, change, delineating between purposes for seeking mental health services, belief that therapists are not well-informed about transgender issues, value of well-informed therapists, couple and family therapists should be well-informed, and loved ones understanding of gender identity. This study provides insight into transgender people's relational issues relevant to couple and family therapy. Phenomenological, narrative and feminist lenses provide frameworks to view these findings. Implications for future research and clinical practice are discussed. / 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.

Sixty families who came to a county mental health center for a substance abuse evaluation for a teenager were interviewed. The parent(s) and teenager were administered the Emotional Cutoff Scale, a paper-and-pencil measure. The functioning of each parent was assessed by the researcher through the Global Assessment of Functioning. The child was evaluated on the Child and Family Assessment Scale, an eight dimension scale. Data were gathered and analyzed through a correlational matrix. Significant correlations at P>.01 were found for degree of cutoff of the mother from her mother and father and her level of self-functioning but not with the level of impairment of the teenager. The sample of fathers did not result in significant correlations. / Ed. 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.

The theory and therapy of Don D. Jackson, MD. is an important piece in the foundation of Marriage and Family Therapy (MFT). It is Jackson's unique Interactional Theory which is viewed by many as the foundation of systemically oriented theories of MFT. This study looked at Jackson's theory and therapy through the eyes of many individuals who worked with him during the most fertile period in MFf history. Individuals such as John Weakland, Murray Bowen, Paul Watzlawick, Jay Haley, Richard Fisch and Jan Beavin-Bavelas were interviewed regarding their understanding of Jackson's influence on the field of MFf. Jackson's theory and therapy were explored in an attempt to gain insight into his unique approach to the therapeutic treatment of individuals within the context of the family. The depth of Jackson's influence on the development of the field is generally recognized however, his influence has been poorly researched. Jackson's departure from the linear orientation of psychoanalysis represents nothing less than a paradigmatic shift. Jackson's Interactional theory was the first theory of human behavior to be grounded in the general systems, communication and cybernetic theories. This change in theoretical orientation laid the foundation for the future development of additional systemically oriented theories and therapies. This dissertation will provide an understanding of Jackson's Interactional theory and therapy as well as provide an understanding of his tremendous influence on the development of systemically oriented family therapies. / Ph. D.

This research explores the question of what role medical family therapists play on a health care team when working with serious pediatric illness. Seven participants from three different health care settings were interviewed. Results were organized within the ecological systems framework (Bronfenbrenner, 1979) according to the various ways participants became a part of the family's illness experience. Participants identified roles directly with the family, with the health care team, and within the larger health care system. Clinical implications are identified concerning the preparation of the health care system for the continued growth and evolution of the field of medical family therapy. / Master of Science

While the Common Factors (CFs) model is becoming more popular it has been criticized for the lack of empirical evidence compared to empirically supported treatments and the lack of capacity to guide clinicians on what to do and when to do it in the course of therapy. This parallel mixed methods study addressed both of these critiques. In phase one, a Common Factors Questionnaire (Karimi-CFQ) was developed to collect empirical data of CFs. In phase two, the Karimi-CFQ was administered to 391 clinicians in the United States to survey the therapists' perspective regarding the contribution of common factors to therapy outcomes. In this phase data was also collected to assess the relationship between clinicians' demographic characteristics and their perceived contribution of common factors to therapeutic change. The CFQ Cronbach's Alpha and Split-half reliability were .84 and .87, respectively. Content Validity Index by expert panel, concurrent validity, and construct validity including Exploratory Factors Analysis (EFA) and Confirmatory Factor Analysis (CFA, χ²=797.96, df=326; RMSEA=.06; CFI=.83) evaluated the validity of the scale. Clinicians across five clinical orientations (Integrative, Cognitive Behavior Therapy, Humanistic, Psychodynamic, Postmodern) and three mental health disciplines (marriage and family therapy, psychology, counseling) attributed 69% of therapeutic change to common factors versus 31% to model-specific factors. Clinicians attributed different contributions to specific components of the CFs model: client (25%), therapist (20%), relationship (23%), hope (12%), non-theory specific (11%), and systemic (9%). Particular clinicians' characteristics (e.g., gender, year of experience) were found to be associated with contributions of specific components of CFs. In phase three, six CF experts were invited to respond to open-ended questions via Wiki that explored how and when experienced therapists use specific common factors in the course of therapy to reach to their therapy goals. Thematic Analysis (TA) generated a chronological map with specific themes that can guide clinicians on how and when specific CFs can be used in each of the three stages of therapy (i.e. Initial, Intermediate, Termination). Findings further indicated that CFs and model-specific factors can be operationally defined and empirically studied within the same evidence-based practice framework. Clinical and research implications of the results are also discussed. / Ph. D.