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

Thesis (M.S.W.)--University of Hong Kong, 1992.

This research study was designed to record and consider lived experiences from marriage and family therapists (MFTs) who have experience with mindfulness as a form of selfcare in sustaining productive professional practices. The primary focus of this project was to understand, through interviews, reports from marriage and family therapists about how they utilize such mindfulness as a form of self-care for their professional practice. This research study has sought insight into whether mindfulness self-care could be helpful in maintaining effective resiliency in professional practice. I used a phenomenological approach, specifically Interpretive Phenomenological Analysis (IPA) interviewing, to gather reports from participants who identify with practicing mindfulness self-care. This study inquired, among various indicators, about whether or not, in their experience, a select group of family therapists’ professional practice is different, and in what way, when they use mindfulness self-care. This research study has elicited lived experience accounts in interviews to inquire whether these accounts can suggest any benefits, personal or professional, from strategies of mindfulness self-care. In addition to statements that specify benefits these family therapists found for themselves, such as enhanced gratitude for the unique positive qualities in their personal lives, they also indicated a circular benefit in that they were able to better handle the stressors of professional practice and even teach the mindfulness self-care practices that worked for themselves to their clients. These benefits of mindfulness self-care in their professional practice further enhanced their understanding that mindfulness self-care helped fulfill them in their personal lives

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).

Although there is little official data, early girls’ marriage before the age of 18 appears to have increased in Tajikistan over recent years, due to the limited socio-economic opportunities. This study aimed to explore the main causes behind the fall in the age of marriage for girls. As Tajikistan is based on patriarchal values, where family is the core of decision-making, the study looks into the family dynamics and interrelationships to analyse the driving forces behind the decision to arrange marriage for the girls at an earlier age. Using triangulated methods of qualitative data collection, such as interviews, focus group discussions and case studies, the study was conducted in urban, semi rural/semi urban and rural areas of Tajikistan. The findings confirm that early marriage exists in Tajikistan. Although marriage has always been important for Tajiks, recently early age of marriage has been more prioritized. The young girls today leave school when they reach puberty, limit their socialization with their friends outside of the house and rigorously learn skills that qualify them as a ‘desirable’ kelin [bride] to increase their chances of getting a marriage proposal within what is a short marriage window. At the same time, the study argues that the family decision to pursue an early age of marriage for daughters is not because of the low status of the women as it has been suggested in some earlier research. Instead, the study argues that marriage is a strategy to provide girls with what is often the only opportunity of an economically and socially secure future in the country under the current socio-economic and political context. Relations within the families are more complicated than dominant-subordinate as previously portrayed but are based on respect, love and responsibility towards each other. This ‘connectivity’ assists in shaping the girls as potent Tajik women ready for their future roles of mothers and wives. The young girls, as this study suggests, are usually not completely powerless either, as they exercise the limited agency provided by the patriarchal system and actively engage in negotiating their interests. Thus, the study aimed to (1) draw attention to the issue of early marriage among girls in Tajikistan and (2) to contribute to the scholarly discussion on early marriage and on gender and family dynamics in Tajikistan. Based on the findings, it is recommended that more research needs to be conducted to discuss the phenomenon of early girls’ marriage in Tajikistan. Further, legal, political and social changes are necessary to provide a safety net for women married at an early age but divorced or abandoned later. Although bringing changes to the marriage values might be a challenging task, it is hoped that this research and others similar to this one will demonstrate the importance of the issue and will result in appropriate attention and an effective policy response.

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.