Melissa Allen - Family Therapy Magazine

Indigenizing the Workforce and Workplace

When I was a newly licensed therapist, nearly 20 years ago, it was even rarer to have access to an Indigenous mental health provider. As a marriage and family therapist, I often heard comments like: “It is so easy to talk to you,” “You understand me,” and “You are not judging me.” These comments were [...]

Growing Diversity in the Field of Marriage and Family Therapy

Marc Fernandez, an internship coordinator for Iona University's Marriage and Family Therapy Program, as well as an adjunct professor, and Christiana Awosan, associate professor, recently sat down for a discussion about growing diversity in the profession and, in general, ways in which they have seen an increase in the diversity of their student populations. A [...]

Smile Through the Pain: The Complexities of Narratives about Mental Health in the Black Community

The perception of mental health in the Black community is multifaceted. There are systemic challenges related to mental health that continue to stand as a barrier to receiving mental health services. Some of these barriers include accessibility of culturally competent providers, cost and/or lack of insurance to see a provider, and historical and present discriminatory [...]

Neurocriminology: A Call on Marriage and Family Therapists and Allied Disciplines to Become Informed

Neurocriminology is an interdisciplinary subfield of criminology that incorporates methodological approaches from neuroscience, physiology, genetics, biology, and psychology. The goal of neurocriminology is to better understand, predict, prevent, and treat criminal and violent behaviors. Although there is no single determinant of such actions, neurocriminology strives to identify different risk factors that increase the likelihood of [...]

Culturally Informed Marriage and Family Therapy with the Chinese Population

In light of the growing recognition of the importance for marriage and family therapists (MFTs) to be sensitive to their clients’ cultural backgrounds and memberships, this article is intended to provide several culturally-informed clinical suggestions for therapists applying Western-based MFT theories, models, and concepts to the Chinese population. When the authors use the term “Chinese [...]

On the Horizons: Barriers and Trends in the Development of Systemic Family Therapy in Africa

Systemic family therapists (SFTs), usually called marriage and family therapists (MFTs) in North America, are trained to conceptualize individual, couple, and family distress within the broader relational and diverse intersectional contexts in which people live. Although the SFT movement originated in Western European contexts, it has since expanded across the globe (Roberts et al., 2014; [...]

Creating Systemic Change Through a Social Justice Lens: Steps to Make Impactful Changes

Social justice is an evolving topic in marriage and family therapy (MFT) as the profession seeks to create this outcome in their clients’ lives and the systems in which they work. Many feel that creating systemic change is our work’s goal and responsibility. In the therapy room and as a leader, we are responsible for [...]

Reasonable Suspicion – Probable Cause – Preponderance of the Evidence – Beyond a Reasonable Doubt

There are many evidentiary standards that have different roles and requirements in our legal system. The one with which practitioners are most familiar is, of course, the one associated both with duty to warn requirements and mandatory reports of child abuse or neglect: a reasonable belief of imminent harm/ reasonable belief that child abuse has [...]

Culturally Informed Emotionally Focused Therapy with African American Couples

Approximately one-third of African American couples in the United States are married. However, research indicates this population tends to experience higher rate of divorce, martial dissatisfaction, and single-parent households, when compared to other racial groups (St. Vil et al., 2019). One may ask, what patterns are we seeing with African American couples that lead to [...]

Helping Black Women Heal Through a Womanist Mental Health and Healing Framework

Helping to heal What does mental well-being and healing look like for black women? How do we as clinicians support the mental health and healing of strong black women? I posture that a Womanist Mental Health and Healing Framework (Melton, 2022) can uniquely address these critical questions. Clinical psychologist Carmen B. Williams (2005) argues that [...]

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