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.

The conditions that allowed early MFTs the freedom to creatively explore different interventions and theories of change are no longer available in today’s mental health care system. Although there are many benefits to the structure of managed behavioral healthcare organizations, a thorough review of the literature demonstrates that many therapists working in managed care agencies struggle with maintaining their theoretical creativity, claiming third-party payers’ service requirements and paperwork a barrier to their creativity. A phenomenological transcendental research method was utilized to understand the phenomenon of successfully combining creativity and accountability in the practice of marriage and family therapy from the perspective of six creative MFTs who have effectively incorporated creative therapeutic techniques into their work, while adhering to the structured requirements of managed care. The findings and themes of the study were organized into two categories. The themes in the Textural / Content Category (description and purpose of therapeutic creativity at a managed care agency) are: (1) Creatively combining the needs of the clients, the different professional entities, insurance companies and you as a therapist, (2) Translating post-modern information into the medical model language that meets the third-party payers’ requirements, (3) Completing documentation with clients, (4) Incorporating technique from a range of therapy models, (5) Keeping clients engaged through a variety of resources and activities, and (6) Utilizing metaphors and themes to uncover patterns of relational dynamics and behaviors. The themes in the Structural / Supportive Conditions Category (factors that allow the balance of creativity and accountability to occur) are: (1) Systemic understanding of how the therapeutic and business systems of managed behavioral healthcare interact together, (2) Having a supportive network of colleagues, (2a) Supportive group of coworkers within the job setting, (2b) Supportive network of MFT colleagues outside of the work setting, (3) Desire to make a difference in peoples’ lives, (4) Continuous education on all aspects of the mental health field, (5) Employers’ support of creative therapy, (6) Self-reflection, (7) Self-care, and (8) Organization and time management.

The mini-dissertation explains how systems theory provided a healing context for me in my training as a clinical psychologist over two years. The emergence of my authentic voice is narrated in an autoethnography (five act drama) about what happened. The main theoretical bases for the dissertation are – constructivism to understand the learning and teaching I experienced; learning as a collaborative endeavour and the emergence of my authentic voice with help from more skilled others. Systems theory informs the entire study at every theoretical level. Bowen’s family therapy theory is significant for the differentiation of the self and his I-position is equated with the emergence of an authentic voice. Myth, epic narratives, the hero’s journey amplify my interpretation of the differentiation of self. The raw data for the qualitative research were observations, interviews, creative writing, photocollage, a collection of readings, songs and dialogues. The themes emerging from the autoethnography were about obstructions because of the authoritarian nature of my upbringing, life and work. These themes lessened in force in clinical training until my authentic voice emerged in relation to self and as a clinical psychologist. A recommendation from the dissertation is that autoethnography provides a good vehicle for reflection and intense interior scrutiny needed to become a practising clinical psychologist; the autoethnographical exercise could be used by training clinical psychologists more extensively on their journey to maturity. / Psychology / M.A. (Clinical Psychology)

Mood disorders are often linked with concurrent partner relational distress. The present study compared the cost effectiveness of treating mood disorder alone versus when the condition is comorbid with partner relational distress. Cigna, a leading health insurance management company in the US, provided outpatient data. Participants included patients with solely a mood disorder diagnosis (n = 72,712) and those with both a mood disorder and a comorbid partner relational distress diagnosis (n = 113, including 69 females and 44 males). These participants were treated in outpatient settings throughout the US. These numbers are surprisingly low considering the extensive literature showing a strong relationship between mood disorder and partner relational distress. A multivariate general linear model and binary logistic regressions were used to analyze the data. Results indicate that having a mood disorder present with a partner relational distress disorder significantly increased the average cost of care by about $471 per person compared to having solely a mood disorder. For mood disorders alone, there were also differences in cost effectiveness and readmission for mood disorders by professional license type, age, and gender with counselors being the most cost effective and medical doctors being the least (60% more costly). The treatment modality used impacted readmission rates, with family therapy having the lowest (8.54%) and mixed therapy having the highest (33.54%). Due to the small sample size, we were unable to determine the significance of subsequent analyses for comorbid disorders. Clinical implications and future directions for research will be discussed.

Generalized anxiety disorder (GAD) is frequently found in primary care settings and is highly prevalent among adolescents. The purpose of this study was to examine the cost effectiveness by provider type and therapy modality in treating adolescents (ages 13-17) with a GAD diagnosis (DSM-IV 300.02). A national insurance company in the United States provided outpatient and unidentifiable data for adolescent GAD cases (n = 2,932). These cases were used to analyze the cost effectiveness, total cost, treatment length, dropout, and readmission rates for the treatment of adolescents with GAD. Descriptive statistics signify that the mean cost of treatment for GAD in the first episode of care across all provider types is $439.28. Results revealed significant differences in cost effectiveness, total cost, treatment length, and readmission rates by provider type and therapy modality. MFTs and counselors were most cost effective, had the lowest total cost and number of sessions, as well as the lowest readmission rate among the provider types. In contrast, MSWs and psychologists were the least cost effective, had the highest number of sessions and the highest readmission rate. Therapy modality comparisons indicated that family therapy is most cost effective followed by individual, then mixed therapy modalities. Significantly fewer sessions were found when conducting family therapy upon treating adolescents with GAD. There were no significant differences in dropout by provider type, therapy modality or age group. The results of total cost by gender were also insignificant. Professional and clinical implications and future directions for research will be discussed.

<p dir="ltr">For many, spiritual beliefs and religious affiliation exist as a protective factor, providing significant emotional, psychological, and social support (Ibrahim & Dykeman, 2011). However, for others, abuse within the power structures of religion can also inflict great harm—particularly within marginalized communities—resulting in religious trauma. The LGBTQIA+ community has historically experienced marginalization and discrimination within various religious contexts and doctrines, becoming a group particularly vulnerable to religious trauma (Simmons et al., 2017; Swindle, 2017). This type of trauma has often been overlooked in the therapy room and within the broader Marriage and Family Therapy field. This thesis addresses this gap through the creation of an introductory training for therapists on religious trauma that many in LGBTQIA+ community experience. Grounded in religious trauma research and trauma-informed client care, the training seeks to enhance therapists' capacity to navigate these complex terrains with empathetic and informed care (Ellis et al., 2022). The aim is to create a therapeutic landscape where healing and self-compassion become more accessible to LGBTQIA+ individuals impacted by religious trauma.</p>

Summaries in Afrikaans and English / Text in Afrikaans / Tourettesindroom is 'n lewenslange versteuring wat gekenmerk word deur motoriese en vokale trekkings saam met moontlik ook komorbiede simptome soos aandagtekort-hiperaktiwiteitsversteuring, obsessief-kompulsiewe versteuring, aggressie en depressie. Die sindroom kom in hoe mate in Suid-Afrika voor en die pastor kan dus heel moontlik daarmee te doen kry. Die beste behandeling vir die sindroom is medikasie saam met gedrags- en gesinsterapie toegedien deur 'n multidissiplinere span. Die pastor het 'n rol om te vervul in hierdie span probleme het aangesien persone met Tourettesindroom dikwels in hulle verhoudings met God, hulleself en ander mense. Vir effektiewe pastorale berading aan sodanige persone, moet die pastor deeglike kennis he van die sindroom en die simptome daarvan, asook van sy of haar invalshoek as pastor. 'n Moontlike kernmoment van die sindroom wat deur die pastor aangespreek kan word, is die verlies aan beheer wat deur dje lyer ervaar word. Die sindroom kan as 'n verskoning gedrag en gebruik word vir negatiewe en onverantwoordelike die pastor sal die lyer dus moontlik eties moet konfronteer op 'n medemenslike wyse. / Tourette Syndrome is a lifelong disorder. Symptoms are motoric and vocalic tics with possible comorbid symptoms such as attention deficit disorder with hyperactivity, obsessive-compulsive disorder, and depression. It is frequent among South Africans and the pastor will probably be confronted with persons struggling with the syndrome. The best therapy for Tourette Syndrome is medication in conjunction with behaviour and family therapy administered by a multi-disciplinary team. Persons with Tourette Syndrome have problems maintaining relationships with God, themselves and others. The pastor therefore has a definite role to play in the team. Knowledge of the syndrome and its symptoms, and of pastoral care are essential for succesful pastoral counseling. A possible central theme of the syndrome is the loss of control experienced by the person with the syndrome. The syndrome can become an excuse for negative and irresponsible behaviour and ethical confrontation may be necessary. / Philosophy, Practical & Systematic Theology / M. Th. (Praktiese Teologie)

How people survive and thrive through adversity is a question which has prompted much research. There is little agreement on the definition of resilience beyond the basic idea of "bouncing back", resulting in many studies which offer contradictory and confusing information. This study sought to organise the literature into broad conceptual categories, and attempted to explain some of the differences in definitions and research methods at the level of paradigm. A need to reconceptualise resilience was identified and undertaken in view of input from ecosystemic, cybernetic and postmodem paradigms. Attention was given especially to the role oflanguage, meaning and description, and the role of the observer/researcher in such a reconceptualisation. Guidelines were offered for approaching research in future. Finally, the context of the researcher was examined in an attempt at self-reflexivity as part of the process of research as proposed in the reconceptualisation. / Psychology / M.A. (Clinical Psychology)