Case Study The Del Sol Family Referral Route Rosa Del Sol was r.docx

Case Study: The Del Sol Family Referral Route
Rosa Del Sol was referred by Christopher’s teacher to the North
Beach Neighborhood Outreach Center. At the time of intake,
Rosa’s presenting concerns were marital conflict and parenting
concerns, especially how to manage her 9-year-old son,
Christopher. Family Composition The Del Sol family consists of
Rosa, aged 35, and Miguel, aged 37, as well as three children—
Christopher, aged 9; Teresa, aged 3; and Tina, aged 18 months.
Rosa and Miguel have been married for 4 years. Christopher is
Rosa’s son from a previous common-law relationship.
Christopher’s biological father, Jim, aged 36, has not been
involved in his life since Christopher was 2 years old, and Rosa
does not know Jim’s whereabouts. Rosa states that Jim was a
heavy drinker and became physically abusive during the
pregnancy, and they separated shortly before Christopher’s
second birthday. Rosa is the only child of Maria and Juan
Valdez, aged 55 and 60, respectively. Juan was verbally and
physically abusive toward Maria, and they separated when Rosa
was 12 years old. Rosa has had no contact with her biological
father since that time. Maria continued to parent Rosa on her
own and has not remarried. Miguel is the oldest son of Sophia
and Thomas Del Sol, aged 62 and 66, respectively. Miguel’s
younger brother, Juan, aged 34, is not married and, according to
Miguel, has a “drinking problem.” Miguel’s father
“abandoned” the family when Miguel was 7 years old. Miguel
remembers the loud arguing and fighting between his parents.
His mother was remarried, when Miguel was 10 years old, to
Ken Wheeler. The Family System Rosa was in tears for most of
the initial session, claiming she “just can’t take it anymore.”
Miguel is constantly putting her down, insulting her in front of
other people (even in the gro- cery store), and yelling at the
children. Rosa feels that no matter what she does, she cannot
seem to do anything right according to Miguel. Rosa is
beginning to realize that she is being verbally abused as her

father abused her mother. She is also uncomfortable with her
reactions because she has been yelling back at Miguel and feels
like the “war is on.”
Rosa feels the situa-tion is “out of control.” Sometimes her
own anger and Miguel’s intensity of anger have frightened her.
Physical abuse has not occurred up to this point, according to
Rosa. She states that Miguel knows that if he ever touches her
that would end the relationship. She is determined not to raise
her children in an “abusive home” like the home of her own
childhood. Rosa says she cries frequently and has had little
energy to deal with the conflicts. Christopher has been having
difficulty at school as well as the daily “battles” with Miguel.
Miguel feels the problems between Rosa and him can be “solved
on their own.” Miguel admits that he yells a lot at Rosa and
calls her names. However, he points out that he always tells
Rosa he is sorry. Miguel is of average height and slim build; he
appears agitated and tense. He admits to experiencing a number
of physical symptoms of stress, including a pounding heart,
frequent headaches, and constant feelings of edginess and
restlessness. Miguel describes himself as a loner with no close
friends. Miguel agrees with Rosa that he is moody but says, “A
guy can’t be in a good mood all of the time.” Miguel’s posture
and manner appear defensive, and he indicates that he is only
here because Rosa had threatened to leave him if they didn’t get
help. His family is important to him, and he realizes now that
despite not wanting to repeat the actions of his stepfather, he
can see that he is doing the same to his children. Christopher
attends North Beach Elementary and Middle School and is in
third grade. He is in a regular class after having repeated first
grade. Christopher was diagnosed with attention deficit disorder
(ADD) 6 months ago. He is currently on a trial of Ritalin. In the
past month, the school has complained to Rosa that Christopher
has become increasingly aggressive with his peers.
Christopher’s teacher reports that he has made no friends in his
class and has become socially isolated, either withdrawing or
acting out angrily. The teacher notes that Christopher has poor

social skills but is quite good in sport activities such as soccer
and football. Christopher’s favorite sport is soccer, and in the
summer he loves to swim, play football, and ride his bike.
Three-year-old Teresa is a talkative girl who is generally good-
natured. Tina, 18 months, tends to be quiet and allows Teresa to
do all the talking for her. Both girls have been achieving their
respective developmental milestones. Rosa has no concerns in
this area. However, Rosa has noticed in the past 3 weeks that
both girls have not been sleeping through the night. They have
been whining and crying a lot more than usual. Teresa
complains of a stomachache frequently. Rosa became upset
when she told about Miguel’s coming home from work and
marching into the bedroom in silence and Teresa asking, “Is
daddy mad again?” Family Background Information Rosa
completed 12th grade and then worked in a bank as a teller until
the birth of Teresa. Her mother helped her raise Christopher
when he was an infant and openly stated her disapproval of
Rosa’s relationship with Jim. Maria lives nearby and, despite
what Rosa describes as a “conflictual” relationship, is a source
of support for Rosa. Maria often babysits the girls, although
Maria now refuses to look after Christopher because “he is too
difficult—just like his father.” Rosa describes the relationship
between her mother and Miguel as “unfriendly”; “they tolerate
one another,” as each tends to put the other down. Rosa feels
stuck in the middle of a “no-win” situation. Miguel never got
along with his stepfather, Ken. Ken frequently became drunk on
the weekends with Sophia leaving the boys to fend for
themselves. Ken was not physically abusive, but when he was
drinking “you stayed out of his way so he wouldn’t yell at you.”
Miguel says his mother Sophia is an alcoholic, and he has
chosen not to have contact with her or his stepfather. Miguel
quit school and left home at age 15. He worked at odd jobs to
support himself. Miguel admits to “being in the wrong crowd”
and being heavily involved with drugs and alcohol as a
teenager. Miguel feels proud that he is no longer involved “in
that scene,” having quit on his own “without anyone’s help.”

Family Strengths and Challenges Stress and Demand Factors
Family System All family members appear to be suffering from
symptoms of stress, both physically and emotionally, and have
experienced a number of changes recently. The purchase of their
own home and the resulting high payments have left little
money to cover remaining bills and groceries. The lack of
money and high debt load have become a daily stressor. Rosa
and Miguel agree that financial issues regularly precipitate most
of their arguments. Christopher’s recent diagnosis of ADD is
confusing to Miguel and Rosa. They have little information on
this disorder or how to best deal with Christopher in managing
his behaviors appropriately. Medication is expensive, and they
do not have health insurance. Marital/Parental Subsystem
Miguel has a sixth-grade education, has always worked, and is
employed full-time at a small auto-repair shop. He also works a
second job in an auto-parts store in the evenings and weekends
to make ends meet. Miguel complains about his coworkers,
stating that he has nothing in common with them and doesn’t
want to waste his time with them. Miguel feels that his boss is
always pressuring him to do more, and they often have loud
disagreements. Miguel aspires to be a manager of his own shop
and not have people telling him what to do. Miguel and Rosa
purchased their home 4 months ago. It is located about 45
minutes by car from their old neighborhood, where Rosa was
well-connected to the church and a number of friends. The
couple enjoy owning their own home, but the mortgage
payments are high. This leaves little money for other expenses
and has been a source of daily conflict. Rosa and Miguel had
decided that Rosa would stay home to care for the girls while
they were young. Lately, however, Rosa has been suggesting
that she work part-time at a gardening shop to help out
financially and to be out of the house.
Miguel then could cut down on his hours of work and spend
time with the family. Miguel reacted angrily to this issue and
stated that he was “sick and tired of everyone hassling him
about working and can’t a guy just make a living.” Miguel

works hard at his two jobs and is very committed to doing the
best for his family. However, all his energies have been devoted
to making a living, with little time for any outside interests.
Rosa disagrees with Miguel about the importance of money and
prefers that Miguel spend time with her and the children as a
family. Miguel admits he is getting physically tired and irritable
and finds he is less able to handle life’s minor annoyances. He
would like to be able to spend time with the children and get
back into playing recreational soccer. Parent/Child Subsystem
Information is incomplete. Sibling Subsystems Information is
incomplete. Resource Factors Rosa describes herself as an
outgoing, social person with a sense of humor, but lately she
has been feeling alone and “down.” The family has one car that
Miguel uses to travel to work, and Rosa feels isolated and
“stuck in the house.” The family has few outside supports.
Rosa, due to the move and transportation limitations, is isolated
from her previous support network, which included
neighborhood friends and the church community. Miguel has
few friends and relies on Rosa to motivate and encourage him.
Rosa has said it feels at times that she has four children, not
three. The girls don’t have friends in the new neighborhood
because the children living nearby are much older. The girls are
becoming quite bored and cranky with Rosa, adding to the
tension in the home. Christopher has made a couple of new
friends; however, his poor social skills and short attention span
have made this a challenge for him. Competence and Coping
Factors Rosa grew up in an abusive home and is determined to
not raise her children in that environment. She is very motivated
to make changes in her life and has attempted over the last year
to involve Miguel in activities to strengthen their family; he has
re- fused to attend any couple enrichment weekends or courses
that were available at no cost through the church. Rosa attended
the sessions on her own, including a weekend retreat for
families. Rosa has a wonderful sense of humor that has helped
her cope with a number of adverse conditions. Rosa feels she
has no support from Miguel in raising the children due to his

drive to make money and his discomfort in being with the
children. Rosa is a good mother to her chil-dren and is
determined to continue to learn about positive parenting
approaches. Miguel is a hard worker, and he feels he must do
the very best in any job he takes on. High expectations create
added pressure and stress. Miguel has been reluctant to tackle
areas in which he feels incompetent. These include parenting, so
he tends to avoid it when he can, often choosing work over time
with the family. Miguel grew up in an abusive, alcoholic family
and exhibits some of the symptoms common to this
environment such as poor self-image, a need for constant
approval, and anger. He believes strongly that the husband’s
role is to provide for his family. Miguel has difficulty
recognizing that his family has needs other than just money
from a husband and father.
This pattern was established in his family of origin. His strong
desire to raise his children differently and to keep his family
together will help him in achieving his goals. Intervention
Planning Miguel and Rosa have decided on the following goals:
1. To develop appropriate strategies for managing anger.
2. To learn effective, respectful communication.
3. To learn more appropriate parent/child discipline strategies.
4. To expand the current support network of their family.
5. To increase their understanding of ADD and parenting
techniques.
Family Therapy Model Chapter
individual assessment in couple and Family therapy A systemic
perspective includes an awareness of individual issues that
interact with couple and family dynamics (Stanton & Welsh,
2012). Nurse and Sperry (2012) note the applicability of several
individual, standardized assessments for couple and family
evalu- ation (such as the MMPI-2, MCMI-III, Rorschach Inkblot
Test, and the Kinetic Family Drawing Test), combining them
with interviews, observation, clinical records, and col- lateral
information to provide input to couples and families (p. 83).

Stanton and Nurse (2009; Nurse & Stanton, 2008) describe a
model of personality-guided couple therapy that uses the
MCMI-III to assess personality factors that interact reciprocally
in couple relationships. The MCMI (Millon & Bloom, 2008) is a
175-item inventory for people who present for therapy; it
provides 14 personality categories and 10 clinical dimensions.
For couples therapy, there are identified couple personality
interaction patterns that may help both individuals understand,
empathize, and manage the personality-driven behaviors in the
relationship. LO 6 Family therapy Process and Outcome
research What constitutes therapeutic change? What are the
conditions within therapy that facilitate or impede such
changes? How are those changes best measured? How effective
is family therapy in general, and are some treatments or
therapeutic models more efficacious than others for dealing
with specific clinical problems or clients from a specific
community or culture?
Do certain therapist or family characteristics influence
outcomes? Is family therapy the most cost-effective way to
proceed in a specific case, especially in comparison with
alternate interventions such as individual therapy or drug
therapy? Or would a combined set of therapeutic undertakings
be most effective in a specific case? How do race, ethnicity,
gender, age, and sexual orientation factor into potential
results? These are some of the questions that researchers in
family therapy continue to grapple with in an effort to
understand and improve the com- plex psychotherapeutic
process. Psychotherapy research investigates the therapeutic
process (the mechanisms of client change) to develop more
effective methods of psychotherapy. There is considerable
research evidence that couple and family therapy is effective for
virtually every type of disorder and for various relational
problems in children, adolescents, and adults (Sexton, Datchi,
Evans, LaFollette, & Wright, 2013; von Sydow, Retzlaff, Beher,
Haun, & Schweitzer, 2013). Now, researchers have turned their
attention to comparative outcome studies in which the relative

advantages and disadvantages of alternate treatment strategies
for clients with different sets of problems are being probed. The
research lens has broadened to examine the application of
couple and family therapy to specific clinical problems in
specific settings, as well as research on process variables that
examines specific change mechanisms (Sexton & Datchi, 2014),
so that differential outcomes from various therapeutic
techniques can be linked to the presence or absence of specific
therapeutic processes. Such investigations may identify
specific interventions that result in more effective treatment
(Hogue, Liddle, Singer, & Leckrone, 2005).
Process Research
How do couples or families change as a result of going through
a successful therapeutic experience? What actually occurs,
within and outside the family therapy sessions, that leads to a
desired therapeutic outcome? Is there evidence for a set of
constructs common to all effective therapies? Do specific
therapies make use of these concepts in different ways that are
effective? The emphasis today has shifted from broad outcome
research to focus on treatment specific- ity, the particular
change mechanisms in couple and family therapy. Clinicians
appreciate this research because it aligns with their experience
of therapy, making research relevant to practice (Sexton &
Datchi, 2014). Process research identifies and operationally
describes what actually takes place during the course of
therapy. These variables impact “how the intervention works
differently in different contexts with different parameters”
(Sexton et al., 2013, p. 590).
What are the day-to-day fea- tures of the therapist–client
relationship, the actual events or interactions that transpire
during sessions that together make up the successful therapeutic
experience? Can these be catalogued and measured? What
specific clinical interventions lead to therapeutic
breakthroughs? How can these best be broken down into smaller
units that can be implemented by others in a manner consistent
with the evidence-based method and thus taught to trainees

learning to become family therapists? Are there specific ways
of intervening with families with specific types of problems
that are more effective than other ways? What role does
therapist gender play in therapy? What about therapeutic style
(proactive or reactive, interpretive or collaborative, and so on)?
What factors determine who remains in treatment and who drops
out early on? How do cultural variables influence the
therapeutic process? In a review of family interventions, Sexton
and colleagues (2013) identified the therapeutic alliance (the
nature of the relationship between therapist and clients);
model-specific fidelity and adherence (faithful implementation
of the model as designed); and client factors (symptom severity,
socioeconomic status, etc.) as major moder- ators and mediators
in the interventions.
From a practical economic viewpoint, family therapy research
must demonstrate to insurance companies, managed-care
organizations, government agencies, and mental health policy
makers that its product is an effective treatment that should be
included in any package of mental health services and benefits
(Pinsof & Hambright, 2002). Process research does not simply
concern itself with what transpires within the session but also
with out-of-session events occurring during the course of family
therapy. Finally, the experiences, thoughts, and feelings of the
participants are given as much credence as their ob- servable
actions. Thus, certain of the self-report methods we described
earlier in this chapter may provide valuable input in the process
analysis. Process research attempts to reveal how therapy works
and what factors (in therapist behaviors, patient behaviors, and
their interactive behaviors) are associated with improvement or
deterioration. For example, a researcher might investigate a
specific process variable concerning family interaction—who
speaks first, who talks to whom, who interrupts whom, and so
forth. Or perhaps, attending to therapist–family interaction, the
researcher might ask if joining an an- orectic family in an active
and directive way results in a stronger therapeutic alliance than
joining the family in a different way, such as being more

passive or more reflective. Or perhaps the process researcher
wants to find out what special ways of treating families with
alcoholic members elicit willing family participation as opposed
to those that lead to resistance or dropouts from treatment. Are
there certain intervention techniques that work best at an early
treatment stage and others that are more effective during either
the middle stage or terminating stage of family therapy? See
Box 16.4 for examples of therapeutic mechanisms that may
initiate change.
Immediate client feedback on the therapeutic process is an
important form of clinically relevant research. Many family
therapists informally invite feedback from clients, but the pro-
cess may be enhanced by the use of more formal means of
monitoring progress, like the Sys- temic Inventory of Change
(STIC: Pinsof & Chambers, 2009) and the System for Observing
Family Therapy Alliances (Friedlander et al., 2006). Both
provide focused questions regarding the therapeutic alliance and
treatment progress. For example, the STIC asks clients to rate
the statement, “Some of the other members of my family and I
do not feel safe with each other in this therapy” (Pinsof &
Chambers, 2009, p. 443). Family therapists may conduct
research on their own interventions by using computerized
feedback systems to inform the process and progress of
treatment (Sexton & Datchi, 2014).
Some models evidence what Heatherington, Friedlander, and
Greenberg (2005) refer to as well-articulated theories about
systemic change processes. Emotionally focused couple therapy
(see Chapter 9) is based on considerable research on the role of
emotion in therapy, integrates such research with attachment
theory, and offers a step-by-step manualized therapeutic plan to
help clients access and process their emotional experiences.
Functional family therapy (Chapter 12) applies behavioral and
systems theories to treat at-risk adolescents. Techniques for
building therapeutic alliances and reframing the meaning of
problematic behavior have been integrated into successful
process studies, especially related to retention in therapy

(Sheehan & Friedlander, 2015).
Empirically supported process studies thus far have been carried
out primarily in the behavioral and cognitive-behavioral
approaches. These brief, manualized treatment methods, with
specific goals, are not necessarily the most effective but are
easier to test using traditional research methodology than other
treatment methods. Least well defined, for research pur- poses,
are the social constructionist therapies. By and large, they have
not yet developed test- able propositions (e.g., how does the
miracle question in solution-focused therapy affect client
outcomes beyond a shift in “language games”?; Heatherington,
Friedlander, & Greenberg, 2005). See Chapters 14 and 15 for
recent attempts at addressing some of these concerns. Sim-
ilarly, while narrative therapists purport to “re-author” people’s
lives, how precisely can that be measured, and how do we know
when re-authoring has been successful? For most models dis-
cussed in this text, greater evidence for the specifications of
change mechanisms is still needed to meet the research criteria
for how best to tap into the therapeutic change process.
Outcome Research Ultimately, all forms of psychotherapy must
respond to this question: Is this procedure more efficient, more
cost effective, less dangerous, with more long-lasting results
than other therapeutic procedures (or no treatment at all)? To
be meaningful, such research must do more than investigate
general therapeutic efficacy; it must also determine the
conditions under which family therapy is effective—the types of
families, their ethnic or socioeconomic back- grounds, the
category of problems or situations, the level of family
functioning, the therapeutic techniques, the treatment
objectives or goals, and so on.
Effective research needs to provide evidence for what models
work best for what specific problems, and under what
conditions (Sexton et al., 2013). This is termed family
intervention research (Liddle, Bray, Levant, & Santisteban,
2002) and may be defined as “a systematic approach to

understanding the practices, their outcomes, and the varying
moderating and mediating variables that may affect the success
or failure of different clinical interventions” (Sexton, Kinser, &
Hanes, 2008, p. 165). By linking process issues with outcome
results, the family therapist would be proceeding using an
empirically validated map. The Society for Family Psychology
of the American Psy- chological Association convened a task
force to develop a classification of evidence-based treatments;
they describe levels of evidence from evidence-informed
(limited research support) to evidence-informed with promising
preliminary evidence (one rigorous research analysis or sev-
eral limited studies) to evidence-based treatment (well-
formulated models with two or more rigorous studies) in order
to categorize family interventions with a commitment to
clinically relevant outcomes (Sexton, Gordon, Gurman, Lebow,
Holtzworth-Munroe, & Johnson, 2011). This model is illustrated
in Figure 16.5. It has been used by Darwiche and deRoten
(2015) to identify multidimensional family therapy (Liddle,
2009), functional family therapy (Alexander et al., 2013;
Sexton, 2011), brief strategic family therapy (Szapocznik et al.,
2012), and family- focused grief therapy (Kissane &
Lichtenthal, 2008) as Level III: Evidence-Based Treatments.
Major reviews of couple and family therapy interventions
establish the efficacy and effectiveness of these treatments for
a variety of treatment issues and client populations (Sexton et
al., 2013; Sprenkle, 2012; von Sydow et al., 2013). Sexton and
colleagues (2013, pp. 589– 590), consistent with the strength-
of-evidence model above, suggest that seven factors must be
considered in rating couple and family therapies: (1)
intervention type, from broad approaches to detailed and
structured methods, perhaps in a manual; (2) clinical outcomes,
“the effectiveness of a CFT intervention for general and specific
client concerns” (p. 590); (3) strength of research reflects the
rigor of the research and the strength of the outcome measures;
(4) client characteristics, including demographic and diversity
factors that impact generalizability of the findings; (5) com-

mon therapeutic processes employed that moderate outcomes;
(6) the context reflects the setting in which the treatment was
provided; and (7) quality is a measure of confidence in the
findings.
Sprenkle (2012) notes the importance of randomized clinical
trials (RCTs) in assessing couple and family therapy
interventions but stresses that RCTs can include qualitative
depth dimensions and common factors. He also notes the more
challenging issue that most RCT research is conducted by the
originators of the specific models under investigation, creating
what he terms “allegiance” issues that warrant caution in the
interpretation of the results. The flip side of this concern is his
finding that the strongest current CFT research, based on
methodology ratings, comes from research teams that have been
together for more than 10 years, focused on specific models like
multisystemic therapy, functional family therapy, or brief
strategic therapy. Additional aspects impacting the strength of
research included use of behavioral outcomes in addition to
self-report, use of concrete outcomes not readily distorted, a
focus on fidelity to treatment design, inclusion of minority
participants, comorbid participants who reflect the prevalence
or co-existing problems in real life treatment, use of multiple
sites with longitudinal follow-up, inclusion of cost
effectiveness, consideration of specific change mechanisms,
inde- pendence of the research (conducted by others than model
developers), and research in real-life practice settings and not
just in a funded research context (Sprenkle, 2012). Evidence
supporting family-level interventions is strong for child and
adolescent conduct or behavioral problems; many combine
family therapy with parenting programs (Sexton et al., 2013).
A review of systemic therapy for child and adolescent
externalizing disorders ex- amined 47 RCTs and found systemic
therapy is equally or more efficacious; no adverse effects;
superior engagement and retention rates, although minority
participants had lower rates than majority participants; enduring
positive effects; and positive outcomes across several aspects of

functioning (von Sydow et al., 2013, p. 608). Family-based
treatments for substance-abusing adolescents, adolescent
bipolar disorder, and youth depression have received empirical
support (Sexton et al., 2013). Sprenkle (2012) provides a
summary list of couple and family therapies that have several
RCTs that demonstrate evidence that they achieve valuable
results; see Table 16.2.
TABlE 16.2 Evidence-based practice: problems/issues with
strong couple and family therapy effects • Adolescent conduct
disorder/delinquency • Getting adolescent and adult substance
abusers into treatment • Adolescent and adult substance abuse •
Childhood and adolescent anxiety disorders • Childhood
oppositional defiant disorder • Adolescent anorexia nervosa •
Family management of adult schizophrenia • Coping for family
members of alcoholics unwilling to seek help • Getting adult
alcoholics into treatment • Adult alcoholism • Moderate and
severe couple discord • Adult depression when combined with
couple discord • Couple violence associated with alcoholism
and drug abuse • Situational (not characterological) couple
violence • Type I diabetes for adolescents and children Source:
Adapted from Sprenkle (2012), p. 25
Evidence-Based Family Therapy: Some Closing Comments The
demand for accountability can be seen in medicine and
education as well as in psychology, where professionals are
being pressured to base their practices on evidence whenever
fea- sible. For psychotherapy, there is increasing momentum to
establish an empirically validated basis for delivering
healthcare services (Goodheart, Kazdin, & Sternberg, 2006;
Kazdin & Weisz, 2010; Nathan & Gorman, 2007), based on the
assumption that clinical interventions backed up by research
will make the effort more efficient, thereby improving the
quality of healthcare and reducing healthcare costs (Reed &
Eisman, 2006). Both researchers and practitioners are interested
in making therapy more effective. Academically based clinical
researchers have been especially supportive of this idea and
have attempted to apply the methodology of scientific research

to the therapeutic endeavor, often developing efficacy treatment
programs under rigorous and controlled conditions that they
believe generalize to real-world problems dealt with by
practitioners. Practicing clinicians, who also would like to base
their interventions on evidence, nevertheless complain that
these narrow treatments based on randomized controlled clinical
trials for specific diagnostic categories are of limited use with
the varied populations and types of problems they see in their
practice (Goodheart, 2006).
Many contend that while the efforts to improve the quality and
cost effectiveness of psychotherapy, as well as enhancing
accountability, are clearly laudable, to date evidence that
empirically validated techniques improve healthcare services or
reduce costs in everyday practice is still limited. The widely
accepted definition of evidence-based practice (APA, 2005) is
as follows: Evidence-based practice in psychology is the
integration of the best available research with clinical expertise
in the context of patient characteristics, culture, and patient
values. The definition affirms the contributions of • • • research
evidence (quantitative and qualitative methodologies, clinical
observations, single-case studies, process and outcome
research) clinical expertise (therapist skill, judgment and
experience in assessment, case formu- lation, treatment
planning, techniques of intervention) patient characteristics
(personality, specific problem, cultural background, gender,
sexual orientation, social and environmental context, race) One
difficulty in reconciling the views of practitioners and
researchers is that they op- erate in different worlds—the
former focused on service to clients, the latter on expanding
understanding of a clinical phenomenon or testing the effects of
new procedures (Weisz & Addis, 2006). Experienced clinicians
are apt to be integrationists, taking what’s most appropriate
from a variety of theories or techniques to help their specific
client or family, and are not likely to be content to follow fixed
rules from manualized guidelines in treating clients who seek
their help. This choice is based on a general conviction that no

one approach adequately addresses every clinical situation that
arises. Westen, Novotny, and Thompson-Brenner (2004) suggest
that researchers might do better by focusing on what works in
real-world practice than on developing new treatments or
manuals from the labo- ratory. There also continues to be debate
on what constitutes research evidence and on the extent to
which psychotherapy is a human encounter in which common
factors (attention from a caring therapist, the expectation of
improvement, catharsis, hope, feedback, safety in a confidential
relationship) help produce successful outcomes, regardless of
therapeutic model (Sprenkle, Davis, & Lebow, 2009).
Nevertheless, there is a growing acceptance of the place of
evidence-based studies in clinical practice, and practitioners
may experience increased pressure from third-party payors and
government agencies to base their interventions on established
evidence-based treatments. Clinicians in the future will be
held increasingly accountable for providing outcome
assessments for their clinical interventions.
Summary
Research in family therapy preceded the develop- ment of
therapeutic intervention techniques, but pri- orities changed,
and the proliferation of techniques outdistanced research. That
situation has now begun to even out, and a renewed family
research–therapy connection is beginning to be reestablished.
Some practitioners, likely in the past to dismiss research
findings as not relevant to their everyday needs and
experiences, have found qualitative research methodologies
more appealing and germane than the more formal, traditional
experimental methodologies based on quantitative methods.
Various models to classify and assess families ex- ist,
employing either a self-report or an observational format. Most
noteworthy are the Circumplex Model of family functioning
based on the family properties of flexibility and cohesion and
the Family Environ- ment Scale. Observational measures, with
which family therapists observe behaviors, have been designed
by Beavers to depict degrees of family competence and by the

McMaster Model to classify family coping skills. Measures of
couple adjustment and individual factors that influence family
dynamics are also used in research and practice. Both the
process and outcome of family therapy interventions have
been studied with increased interest in recent years. The former,
identifying what mechanisms in the therapist–client(s) en-
counter produce client changes, helps ensure greater therapeutic
effectiveness. Outcome research, including both efficacy and
effectiveness studies, having established that marital and family
therapy are beneficial, has turned its attention to evidence-based
practices—what specific interventions work most effectively
with what client populations. Of particular interest today is
the search for the relative advantages and disadvantages of
alter- native therapeutic approaches for individuals and families
with different sets of relational difficulties. Evidence-based
family therapy is likely to become increasingly important due to
efforts to make therapy more effective and cost efficient.
Title
ABC/123 Version X
1
Week 5: Business Structure Matrix
MGT/465 Version 2
2
University of Phoenix Material
Legal Business Structure Matrix
Complete the following sections using the provided matrix
template.
· Develop a legal business structure matrix that describes the
differences between each business structure.
· Write out your explanations in each section; each section
should contain about 350 words.

· Format your consistent with APA guidelines.
Structure
Definition/Characteristics
Liabilities
Taxes
Legal Prerequisites to Begin Operations
Sole Proprietorship
“C” Corporation
Limited Liability Partnership
“S” Corporation
Partnership
Limited Liability Company

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