Ph.D., Antioch University, 2019, Antioch New England: Marriage and Family Therapy
Since the 1980's there has been a proliferation of home and community-based mental health
services developed to meet the needs of families with children with severe emotional or
behavioral problems as an alternative to residential or institutional placement (Macchi &
O'Connor, 2010; Zarski, Pastore, Way, & Shepler, 1988). Despite this long history, home-based
family therapists are still trying to define best practices for home-based family therapy (HBFT).
In the literature, the management of professional roles has been defined as a practice element
worthy of attention. For instance, in an analysis of home-based programs, researchers identified
providers having multiple roles as one of nine program elements that were effective in
preventing placement of youth with behavioral and mental health needs (Lee et al., 2014).
However, studies of clinicians providing HBFT indicate that multiple roles and associated
boundary issues often present ethical challenges (Snyder & McCollum, 1999; Stinchfield, 2004;
Worth & Blow, 2010). A constructivist grounded theory methodology was followed to address
the question: How do marriage and family therapists manage multiple professional roles in the
context of providing home-based family therapy? Twelve MFTs with experience in HBFT
participated in semi-structured interviews, contributing their experience and knowledge to the
construction of a pragmatic model of being professional and cultivating professional agency. Six
agentic practices were identified, labeled as reflective, communicative, adaptive, proactive,
relational, and sustaining practices. This model contributes to understanding professionalism in
home-based family therapy and adds to the broader discussion of managing multiple roles other
multi-disciplinary settings.
Committee: Kevin Lyness PhD (Committee Chair); Megan Murphy PhD (Committee Member); Barbara Andrews PhD (Committee Member)
Subjects: Counseling Psychology; Ethics; Therapy