Melissa Allen, Author at Family Therapy Magazine

Temperament: An Important Key to Understanding Oneself and One’s Relationships

Most people know the word temperament, but not really what it means. We’re born with nine different temperament traits, and they range from low activity to high activity. There is no bad trait; all of our qualities can be helpful or problematic depending on the circumstances and how we use them. Our personalities are made [...]

Clinical Approaches to Psychotherapy: Distinctive Features, Common Ground

Because there is so much confusion about the multitude of modalities and differences among clinicians providing psychotherapy, the following will briefly describe some common approaches, rooted in psychoanalytic origins, with a focus on the unique contributions of the systemic perspective of marriage and family therapy training. This will also describe some distinctive features of the [...]

Turning Down the Heat at Home: How Family Mediation Helps Resolve Conflict Before It Breaks Relationships

Adult siblings not speaking, parents and children at odds, tensions rising over decisions that feel impossible to agree on. Conversations turn into arguments. Small issues become symbolic of something bigger. Everyone feels misunderstood. And eventually, someone mentions lawyers. Family conflict rarely starts with a single issue. More often, it builds slowly during periods of transition—when [...]

From Shadows to Strength: Exploring Family, Relationships, Self, and the Making of the Therapist

Friedrich Nietzsche once said, “Family love is messy, clinging, and an annoying repetitive pattern, like bad wallpaper.” My family has carried patterns as ugly as bad wallpaper, including intergenerational scripts of anger, estrangement, and survivalism that repeated themselves with paralyzing predictability. But like wallpaper, patterns can be stripped away and replaced with something new, something [...]

The Space Between Us: A Systemic Approach to Relational Endings

Relational endings might be one of the experiences that can reveal the most vulnerable parts of ourselves—ruptured stories collapsed into an idea of what could have been. In our capacity as systemic practitioners, we get to listen to several stories of longing: romantic relationships that have dissolved without notice, friendships that no longer hold, family [...]

Closing the Gap Between Knowing and Doing: AI Avatars in MFT Training

A graduate student begins a session with a couple. One partner does most of the talking. The other gives short, brief answers. Inside of two minutes, the talkative partner keeps pressing the student to take their side, and the student has to decide, right then, whether to follow their lead or turn toward the quieter [...]

When the Bedroom Becomes a Battleground: Treating Sleep Anxiety in Couple Therapy

Shelly tried everything. Melatonin. White noise. Blackout curtains. A sleep tracker that glared at her from the nightstand like a Cheshire cat. By the time she started seeing me, she had not slept more than four hours a night for three years; and her marriage was quietly unraveling. Her husband, Jared, had decamped to the [...]

Yours, Mine, and Ours: Helping Couples Organize Money

There is a question most therapists rarely think to ask, yet the answer can open the door to some of the most revealing clinical conversations: How do you and your partner actually organize your money? Not “Do you fight about money?” That question is common enough. This one is more specific: Do you pool everything, [...]

Optimizing MFT Professional Socialization Development: Using the 4C Assessment Model in Supervision

Supervision is a crucial aspect of the development of competent, ethical marriage and family therapy (MFT) professionals providing quality client care in practice. Supervision is an ongoing professional relationship focusing on MFT clinical skills development, often including strengthening systemic thinking through case conceptualization, teaching and supporting clinicians’ use of systemic models and interventions in their [...]

High-Conflict Communication in Blended Families: Helping Everyone Feel Heard Without Escalating Conflict

After a divorce or separation, clients can feel as though everything is a fight. It isn’t that they are high-conflict people. More often, they have developed a pattern of communication in which conflict is expected before the conversation even begins. Now add the complexities of a second relationship and additional children, and the dynamics of [...]

TREATNET Family and the United Nations: Family Therapy with Adolescents at Risk of Substance Abuse and Contact with the Criminal Justice System

In 2018, we (LLC and MP) met in person for the first time in the lobby outside a large conference room at the United Nations Office in Vienna. Although we had collaborated previously (Palit & Levin, 2016; Charlés & Samarasinghe, 2016), we had never met face-to-face. In Vienna, we were invited participants in a United Nations Office on Drugs and Crime (UNODC) technical consultation: “Elements of Family-based Treatments for Adolescents with Drug Use Disorders: Creating Societies Resilient to Drugs and Crime.” This consultation meeting included 25 experts across the fields of family therapy, staff from the UNODC PTRS unit, and the World Health Organization, and subject matter experts in substance use disorders and countering violent extremism. The meeting was convened for a memorable week in Vienna, with participants from over 13 countries. The goal of the meeting was “to identify key elements of effective approaches to the treatment of adolescents with drug use disorders and to provide guidance for the development of a UN training package on family therapy.” A key aspect of the “effective approaches” and “guidance” asked of us as a group of technical experts was that we had to consider FT adaptation and implementation in low and middle income countries. The challenge is clear; while research studies in many contexts illustrate how systemic family therapy practices are part of the evidence base, Busse et al. (2021) noted that:

…almost all these studies were conducted in high-income countries and almost all of them were conducted within a research context in university setting. As such, the findings might not be generalisable to studies conducted in LMICs …. Furthermore, adolescents with SUDs and their families in LMICs do not have or very little access to effective treatment such as family-based therapy. To address this accessibility gap as well as to increase quality and diversity of treatment options for adolescents with drug and other SUDs, the Treatnet Family (TF) was developed by the United Nations Office on Drugs and Crime (UNODC; 2020). (p. 2)

That package that was begun in 2018 in Vienna is now called Treatnet Family (see below for an example of some of the concepts addressed in the package). Treatnet Family has been a part of feasibility studies, has been implemented in many countries and regions, and involved hundreds of practitioners across the globe. The package is openly accessible at no cost, and as of this writing, has been translated into four languages, with more on the way. We need more multilateral efforts and collaborations like this one, and family therapy as an established field needs to hear much more and much more often about the ways practice must be adapted to meet country contexts across the globe.

A recent publication by Busse et al. (2021) described Treatnet Family (TF) as:

containing elements of evidence-based family therapy which has been developed specifically for adolescents with SUDs and their families in low resource settings. TF focuses on family interactions and uses elements of family therapy to interrupt ineffective communication within the family. It contains the key components of family therapy, such as:

positive reframing (i.e., positive labeling of a negative behavior without necessarily accepting it as fine. It involves emphasizing the possible positive intent behind a seemingly negative behavior),
positive relational reframing (i.e., positive labeling of a negative behavior in relationship to the family without necessarily accepting it as okay. Even when the behavior is self-destructive, the intent behind it can be understood and appreciated, yet not necessarily condoned).
perspective taking (i.e., developing empathy and the ability to take another person’s viewpoint into account).
relational questions (i.e., to support perspective taking, relational questions are asked [e.g., “When Narendra gets into trouble, who feels most sorry for him?”] in order to encourage perspective taking and relational thinking).
going with resistance (i.e., helping family members feel heard and understood, which reduces defensiveness and makes more productive conversations possible).

TF has six sessions, with each session lasting between 90 and 120 minutes. Each session is to be attended by the adolescent with SUDs and his/her family members because the primary focus of the sessions is on the relationships among family members. The practitioner’s role is to interrupt problematic cycles, ineffective communication, and harmful behaviors family members currently use to meet their emotional and interpersonal needs. As change in family interaction can influence each family member’s behavior, family members are encouraged to be part of the solution.” (p. 2)

For more on Treatnet Family: https://www.unodc.org/documents/southeasterneurope/UNODC_Treatnet_Family_brochure_190320.pdf

Author: Melissa Allen