Till the ocean do us part: Italian and American therapists representations of stepfamilies in treatment

Abstract

Research often focuses on the characteristics of stepfamilies and their differences with first-union families; however, few studies take into account the therapist’s perspective with regards to the treatment of such families. Also, cross-cultural research on the topic is limited. To fill these gaps, a content analysis of responses from 125 Italian and 45 American therapists regarding their representations of stepfamilies and stepfamily therapy was undertaken. Results show that American therapists emphasized specific stepfamily characteristics (<em>e.g.</em>, the lack of a shared family history, the occurrence of conflict between former spouses, the presence of unrealistic expectations towards treatment) to a greater extent if compared to Italian therapists. By contrast, besides being more general in their definition of stepfamilies, Italian therapists focused more on themselves, their theoretical models, and their professional and personal skills. The study provides insights on both the differences in the clinical cultures of the two countries and implications for stepfamily therapy and training.

Moment-by-moment interpersonal behaviors in poor vs. good psychodynamic psychotherapy outcomes: Does complementarity say it all?

“…When reflecting on what therapists are typically expected to do ( i.e ., focusing on the Other transitively), our subjects proved capable of showing protection (see Tables 1 and 3 ), while also adopting a controlling stance; however, such control sometimes resulted in disaffiliative unfriendly behaviors (see Table 1 ), as well as in a tendency to focus on the Self in the nonresponders group (see preliminary chi-squared testing). In conclusion, this research shows that even well-trained therapists are somehow vulnerable to engaging in disaffialitive and hostile dynamics (Accordini et al, 2017 ; Ackerman & Hilsenroth, 2001 ; Henry et al, 1990 ; Tanzilli et al, 2017 ), and, likely, this should be appraised as the sign of a progressively “therapists’ discouragement” (von der Lippe et al, 2008 , p. 430). Thus, the lack of caution that even well-trained therapists seem to show especially when dealing with challenging patients displaying dysfunctional behavioral patterns (Margola, 2020 ; Norcross & Wampold, 2011 ) contradicts the idea according to which therapists should adopt a countertransferencially-disciplined attitude (Gabbard et al, 1994 ; Høglend & Gabbard, 2012 ), that is, should avoid countertransferential acting out while maintaining a more balanced and poised attitude.…”

“…Lastly, when focusing on the therapist's role, studies on the effects of their training on treatment responses are still lacking systematization (Beutler et al, 2004), with the result of jeopardizing the quality of research findings and concluding that this variable does not make a difference (Mahrer, 1999) or, when it does, such difference is mediated by other variables (e.g., interpersonal skills irrespective of years of experience in clinical practice; Stein & Lambert, 1984). On the contrary, it is quite indubitable that even experienced clinicians might engage in destructive and dysfunctional dynamics (e.g., Accordini, Browning, Gennari, McCarthy, & Margola, 2017;Ackerman & Hilsenroth, 2001), especially when patients are characterized by negative or ambivalent IPIRs, overall hostility, early negative responses to treatment, and, more in general, low levels of interpersonal complementarity (e.g., Henry, Schacht, & Strupp, 1986;Henry et al, 1990;Lambert & Ogles, 2004;Orlinsky et al, 2004;Tanzilli, Muzi, Ronningstam, & Lingiardi, 2017;von der Lippe et al, 2008).…”

“…Thus, it would be important to understand whether the use of self-disclosure signals a congruent underlying interpersonal complementarity ( i.e ., it implies the therapist being receptive), or if it is rather a form of self-defense, that is, the tangible sign of the therapist’s weakening him/herself (von der Lippe et al, 2008 ) in the face of the dyad’s asymmetry. As if—when in difficulty— therapists disengage themselves and focus inward, in a self-soothing attempt (Accordini et al, 2017 ; Ackerman & Hilsenroth, 2001 ; Tanzilli et al, 2017 ). What we know for certain is that self-disclosure is used rather frequently by the therapists in our sample, especially when treating good-outcome cases (see Tables 2 and 3 ).…”

From First-Union Separation to Stepfamily in Italian Context: Building a Stepcouple Identity

“…In parallel to research, clinical practice with the stepfamilies is also less widespread in Italy. Recently, Accordini et al (2017) examined and compared American and Italian therapists’ representations about stepfamilies and highlighted a lack of specificity in the Italian clinicians’ representations of stepfamilies and, as a result, a clinical practice driven by first-union family theory. Therefore, it seems pertinent to expand the knowledge about the specificity of the transition to the stepfamily in Italian context, focusing on the conditions for single parents to find a new partner and the processes of stepcouple identity building.…”

“…The evolution of research on stepfamilies reflects the exponential growth of the phenomenon in the United States as well as in Europe. Nevertheless, research on stepfamilies in Italy is still in its infancy (Accordini, Browning, Gennari, McCarthy, & Margola, 2017). Italy is one of the European countries with the lowest number of stepfamilies and is characterized by a predominance of nuclear families and a low divorce rate (Steinbach, Kuhnt, & Knüll, 2016).…”