Investigating couple relationships and change during couple and family therapy : A specific focus on domestic violence and work functioning

The aims of this thesis were to investigate couple relationships and change in those relationships during couple and family therapy, with a specific focus on domestic violence and work functioning. The first subsidiary aim was to assess, theoretically and empirically, what level of simplification should be applied to the comprehensive measure used in this study. The second subsidiary aim was to examine the physical couple and family violence among clients receiving couple and family therapy. The final subsidiary aim was to analyze the clients’ change in work functioning from pre- to posttreatment. The clients who participated in this study (N=841) can be considered as representative of clients in couple and family therapy in Norway when considering income, the number of children, educational level, prior experience with therapy, and levels of distress on individual and relational measures. Domestic violence is commonly mentioned in the news because the consequences sometimes are fatal. However, research on domestic violence on clinical samples is sparse, and it has often failed to differentiate between emotional and physical violence. Furthermore, violence between others in the family besides the couple has, to the best of my knowledge, not been included. Outcome studies of couple and family therapy most often focus on relational functioning or individual distress. However, work functioning has, to the best of my knowledge, not been used as an outcome measure.publishedVersio

Physical couple and family violence among clients seeking therapy: identifiers and predictors

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Addressing the construct validity of the “individual problems and strengths” scale

Background: Routine Outcome Monitoring (ROM) systems have been used to monitor how a client’s life changes over the course of therapy. However, if a ROM system is to be used, the system should have sufficient construct validity to warrant its usage. In the current study we sought to test the construct of the “individual problems and strengths” (IPS) measurement scale, a sub-section of the “Systemic Therapy Inventory of Change” (STIC). Methods: We used a factorial construct validation procedure utilizing a stepwise confirmatory factor analysis approach on a sample of 841 clients of couple and family therapy. Results: We found support for the original “8-factor” version of the IPS but failed to find support for the “1-factor” version and the “higher order factor structure”. Conclusions: The investigation uncovered that the measurement tool is still under development and since the factorial construct (and the scale-reliability) was only supported for the original "8-factor" model, we encourage a pause in administering the IPS in clinical practice.acceptedVersio

Å bli familieterapeut: En kvalitativ studie av videoveiledning i familieterapiutdanning

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Efficacy of emotion-focused parenting programs for children's internalizing and externalizing symptoms : a randomized clinical study

Objective Emotion-Focused Skills Training (EFST) is a 12-week parental program based on Emotion-Focused Therapy, developed to improve children and adolescents' mental health problems. Methods In a randomized clinical dismantling study, including parents of 236 children and adolescents (ages 6–13, Mage 8.9, 60.6% boys, 95.8% Caucasian) with externalizing and/or internalizing problems within clinical range, we examined the efficacy of two versions of EFST: one experiential condition (n = 120) involving emotionally evocative techniques and two-chair interventions, and one psychoeducational only condition (n = 116) involving didactic teaching of emotion skills. Both groups received a 2-day group training and 6 hours of individual supervision. Outcomes were parent- and teacher-reported symptoms at baseline, posttreatment, and 4-, 8-, and 12-month follow-up. Analyses were conducted using multilevel growth curve modeling and Bayesian post hoc analysis. Results EFST showed efficacy in reducing parent-reported externalizing (b = −1.72, p .05, d = 0.2) symptoms. Multilevel analyses showed nonsignificant differences between conditions (all p's > .05), although a Bayesian longitudinal sensitivity analysis indicated a better outcome for the experiential condition. Conclusion EFST showed efficacy in symptom reduction for children and adolescents with internalizing and externalizing symptoms. Outcomes were maintained over 12 months for both conditions, supporting EFST as a transdiagnostic parental approach for early intervention

Investigating couple relationships and change during couple and family therapy : A specific focus on domestic violence and work functioning

The aims of this thesis were to investigate couple relationships and change in those relationships during couple and family therapy, with a specific focus on domestic violence and work functioning. The first subsidiary aim was to assess, theoretically and empirically, what level of simplification should be applied to the comprehensive measure used in this study. The second subsidiary aim was to examine the physical couple and family violence among clients receiving couple and family therapy. The final subsidiary aim was to analyze the clients’ change in work functioning from pre- to posttreatment. The clients who participated in this study (N=841) can be considered as representative of clients in couple and family therapy in Norway when considering income, the number of children, educational level, prior experience with therapy, and levels of distress on individual and relational measures. Domestic violence is commonly mentioned in the news because the consequences sometimes are fatal. However, research on domestic violence on clinical samples is sparse, and it has often failed to differentiate between emotional and physical violence. Furthermore, violence between others in the family besides the couple has, to the best of my knowledge, not been included. Outcome studies of couple and family therapy most often focus on relational functioning or individual distress. However, work functioning has, to the best of my knowledge, not been used as an outcome measure

Forandring fryder? Utfordring, utvikling og muligheter. En kvalitativ undersøkelse om noen familieterapeuters opplevelser av forandringer på eget arbeidssted, og innvirkningene dette har på deres praksis

Denne oppgaven belyser familieterapeuters opplevelser av forandringer på eget arbeidssted, og innvirkningene dette har på deres praksis. Det er tre sider ved forandringene som settes i fokus. I hvilken kontekst ser de forandringene? Hvordan oppleves forandringene? Fører forandringene til at de gjør ting på noen nye måter eller tenker noe annerledes enn før? Oppgaven baserer seg på en kvalitativ undersøkelse utført ved familieklinikken og familiepoliklinikken ved Sørlandet sykehus, våren 2008 til våren 2009. Forandringene som står i sentrum er en forestående sammenslåing av de to avdelingene, og et samarbeidsprosjekt med Universitetet i Agder. Undersøkelsen har en fenomenologisk tilnærming, noe som betyr at informantenes egne opplevelser og forståelser står sentralt. Analysen tar utgangspunkt i teorier om organisasjonskultur, organisasjonsforandring, kontekst og mening, samt den narrative metafor. Med disse teorier belyses hvordan forandringene oppleves og påvirker terapeutene i deres arbeid. Oppgaven viser i særdeleshet hvordan konteksten den enkelte ser forandringene i innvirker på terapeutene. I materialet vises to vidt forskjellige kontekstforståelser. Dette påvirker både opplevelsen av forandringene og innvirkningen av dem. Noe annet som virker inn i møtet med forandringene er terapeutenes livshistorier i forhold til forandringer tidligere i livet. Det vises hvordan noen hilser forandringene velkommen, med dette som bakgrunn. Oppgaven har også et lokalt fokus knyttet til forandringene ved de to avdelingene. Det vises til hvordan studenter i terapirommet påvirker både klienter og terapeuter. Arbeidsbelastningen har steget, og ulike former for forandringstretthet er blitt tydelige. Samtidig med dette er refleksjonen over egen praksis og teori høynet

Change in work functioning from pre- to post-treatment in feedback-informed Couple and Family Therapy in Norway

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Effectiveness of emotion focused skills training for parents: study protocol for a randomized controlled trial in specialist mental health care

Background Emotion-Focused Skills Training (EFST) is a newly developed manualized skill training program for parents to strengthen emotional bonds between parents and children and improve mental health outcomes in children. Results from several preliminary trials indicate that EFST can be quite effective, but more rigorous methods are needed to affirm the evidence of the program. The primary objective of this study is to compare the effectiveness of EFST to treatment as usual (TAU) in a Norwegian outpatient clinic for child and adolescent mental health. Additionally, the study will examine the basic theoretical assumption underlying EFST that increased parental emotional functioning predicts a decline in children’s mental health symptoms.  Method  120 patients will be randomly assigned to either EFST or TAU. The main outcome measure is the semi-structured diagnostic interview Schedule for Affective Disorders and Schizophrenia, present and lifetime version (K-SADS-PL) scored by trained assessors administered at pretreatment and repeated after 3 months. The secondary outcome measure is the DSM-IV version of the Strength and Difficulties Questionnaire (SDQ) administered at pretreatment as well as 3, 6, and 12 months after the intervention. To examine the efficacy question, effect sizes and reliable change for each of the treatment arms will be assessed as well as symptom differences between the conditions. To examine the second aim of the study, we will examine (1) how parents relate to emotions in their children assessed by the Emotion-Related Parenting Styles (ERPS), (2) the parents’ emotion regulation capacity assessed by the Difficulties in Emotion Regulation Scale, short-form (DERS-SF), and (3) parents’ sense of self-efficacy and the strength of their relationship with the child will be assessed by the relationship with child scale (RWC) of the systemic inventory of change. Discussion This study will provide insights into the effectiveness of EFST in improving children’s mental health and the mechanisms of change responsible for the program’s effectiveness. Impotently, this study may provide information regarding whether children’s mental health issues can be alleviated through therapeutic work provided to the parents alone. Trial registration Clinical trials.gov Identifier: NCT04885036 . First Posted on May 13, 2021. Trial status: In recruitment