Therapist attentiveness and negative capability in dialogical family meetings for psychosis

Jaakko Seikkula (2008) has pointed towards the importance of practitioners working in the present moment in dialogical therapy. Extrapolating from Seikkula's work, this article considers the significance of the qualities of therapist attentiveness, generosity and negative capability in dialogical family meetings for psychosis. It is proposed that these qualities are of particular importance when family meetings occur in crisis situations, as when under pressure practitioners can easily be drawn into prematurely interventionist stances that may unintentionally promote chronicity for the person experiencing psychosis. The value of co‐working arrangements in enabling practitioners to maintain attentiveness and negative capability in this work is also considered.     

Multiple family therapy in a residential setting for adolescents*

Treating severely disturbed adolescents in a residential setting without including the family seems impossible. Several ways of letting the family participate in the clinical treatment are discussed. The focus of this article lies in multiple family therapy: groups of family members, adolescents and staff are treating each other. The objects of these meetings are manifold: to modify the stereotyped views that all the participants have of each other, to reduce the isolation of the family which is created by their child's admission, to stimulate interaction and mutual correction between family members, adolescents and staff, and to create a warm-up for and understanding of family system therapy. These multiple family sessions, which take place in a clinic with sixty disturbed adolescents, have a strong influence on the entire therapeutic process. Their impact is felt in the group psychotherapy, psychodrama and other forms of therapy.     

Improving partnerships with families and carers in in‐patient mental health services for older people: a staff training programme and family liaison service

In spite of policies advocating the involvement of families in the care of mental health service users in the UK, there are few examples of initiatives to develop staff confidence and skills in partnership working. This article describes a whole team training initiative and family liaison service to promote family inclusive working on in‐patient wards for older people in Somerset, UK. A three‐day staff‐training programme is described and training outcomes are reported. Staff report a substantial increase in confidence and family meetings held. A pre‐and post‐ training case note audit shows increased consideration of the needs of families. To further increase face to face meetings with families a family liaison service has been established, whereby a staff member with systemic family therapy training joins ward staff to hold family meetings as part of the assessment/admission process. Evaluation of this service has shown it to be effective with positive feedback from families and staff.     

Need-adapted treatment of schizophrenic processes: The essential role of family-centered therapy meetings

Need-adapted treatment is a psychotherapeutically oriented approach to psychoses that has been planned and is implemented individually in each case, combining different activities so that they meet the needs of each patient as well as the people making up her or his personal interactional network (usually the family). A systemic initial intervention, carried out as a conjoint session of the patient, the family members, and a team of 3–4 staff members is an essential part of this approach. The name therapy meeting was given to these sessions because of their notable therapeutic significance. Therapy meetings are often continued during the later phases of treatment to follow up the course of treatment and to reassess the therapeutic plans.     

Beyond the family; using network meetings with statutory child care cases

This article describes and discusses the use of network meetings in child care cases. It draws on the literature of network therapy and family therapy and adapts it to a new setting. It describes two cases in detail and raises questions about the limitations of family therapy to the development of systemic thinking. It also includes a practical guide to the use of network meetings.     

Making sense of ourselves: self-narratives and personal identity

Some philosophers take personal identity to be a matter of self-narrative. I argue, to the contrary, that self-narrative views cannot stand alone as views of personal (or numerical) identity. First, I consider Dennett’s self-narrative view, according to which selves are fictional characters—abstractions, like centers of gravity—generated by brains. Neural activity is to be interpreted from the intentional stance as producing a story. I argue that this is implausible. The inadequacy is masked by Dennett’s ambiguous use of ‘us’: sometimes ‘us’ refers to real human beings, and sometimes ‘us’ refers to selves or fictional characters. Second, I consider Schechtmann’s view that self-narratives create persons (in the sense that she calls ‘characterization’ or personality. I argue that the sense in which a self-narrative creates a person cannot stand on its own: a person must already exist (in the sense of numerical identity) in order for there to be a self-narrative. Finally, I offer my own account of persons.     

Diagnostic validity of the Eppendorf Schizophrenia Inventory (ESI): a self-report screen for ultrahigh risk and acute psychosis

Providers of mental health services need tools to screen for acute psychosis and ultrahigh risk (UHR) for transition to psychosis in help-seeking individuals. In this study, the Eppendorf Schizophrenia Inventory (ESI) was examined as a screening tool and for its ability to correctly predict diagnostic group membership (e.g., help seeking, mild psychiatric complaints, highly symptomatic mood or anxiety disorder, UHR, acute psychosis). Diagnostic evaluation with established instruments was used for diagnosis in 3 research samples. UHR status was assessed with the Structured Interview for Prodromal Symptoms/Scale of Prodromal Symptoms (Miller et al., 1999) and the Bonn Scale for the Assessment of Basic Symptoms Prediction list (Gross, Huber, Klosterk?tter, & Linz, 1987; Klosterk?tter, Hellmich, Steinmeyer, & Schulze-Lutter, 2001). This study showed that members of different diagnostic groups rate themselves significantly differently on the ESI and its subscales. A new subscale was constructed, the UHR-Psychosis scale, that showed good utility in detecting individuals with interview-diagnosed UHR status and acute psychosis. The scale is also sensitive to the threshold between UHR and acute psychosis. Practical applications of the ESI include use as a diagnostic tool within various settings.     

Psychotherapieplanung bei “schwierigen Patienten”

This article describes a model of comprehensive psychotherapy planning for difficult patients, especially patients with borderline personality disorders and psychotic disorders. Its aim is to develop a psychotherapeutically orientated approach to treatment corresponding to the individual needs of the patient and the people closest to them (e.g. family).Central elements of the planning process are diagnostic/therapeutical family meetings in which psychoanalytic and systemic conceptualisations are applied together. The main features of this context oriented model development are described and illustrated by case studies.The article also presents first results of an analysis of the therapy plannings and discusses the questions arising.     

Spatiality of the family's inner structure: choice of seat in family therapy

Many family therapists have observed that the family's choice of seat in the family therapy session provides information concerning the inner structure of the family. The purpose of this study was to study certain aspects of this observation. The selection of seats in family therapy sessions and the mutual distances between family members were investigated for 13 families. The inner structure of the family is described in terms of the existence of problematic relationships and the distribution and quality of power as assessed by the family therapists. The family members' selection of seats in the family therapy session was compared to the sitting order at meals, watching TV at home, and family drawings. It was found that the distance between the father and the patient (a son or daughter) and the location of the father and the mother in relation to each other in the family therapy are more related to the inner structure of the family than to situational factors.     

A Piagetian View of Family Therapy: Selvini-Palazzoli and the Invariant Approach

The Invariant Approach of Mara Selvini-Palazzoli is a new development in the Milan approach to family therapy. In order to distinguish and explain it, an overview of the Invariant Approach is given. Jean Piaget's theory of cognitive development is used to provide a framework for explaining how Selvini-Palazzoli's therapy alters the family's epistemology and facilitates change in the "family game." It is suggested that family members in therapy tend to think about their problems in a style that resembles Piaget's preoperational period. The process of therapy can be seen as geared to facilitate a shift from a preoperational to an operational style of cognitive functioning. This shift gives family members access to more adaptive ways of thinking about their problem-solving strategies.     

Fiction as an aid to therapy: a narrative and family rationale for practice

Stories of literary merit written by others (novels, plays, etc.) can be used in therapy to help people tell their personal stories. Existing approaches to the use of fiction draw mainly from psychoanalytic assumptions. From a narrative and family perspective, the claim is that when persons of all ages spontaneously report on the content of a favourite story, this story functions as a 'safe' vehicle for them to talk about their own lives, experiences and emotions that have been marginalized or shaped to fit transgenerational themes. In addition, the form of a favourite story can help in the transformation of a non-intelligible and/or pessimistic self-narrative. A case example is used to illustrate the suggested steps for working with clients on a favourite novel. The therapist encourages family member(s) to claim ownership of the assumed experiences, wishes and positive life developments of their favourite characters, and to help them see the narrative structures and linguistic features they have used for the various retellings of the story as properties of their own self-narratives.     

Techniques for Group Family Enrichment

This article introduces a creative approach to family enrichment. The program emphasizes educational skill-building techniques using nontherapuetic approaches that enable families to resolve difficulties of family members. The meetings, which employ coaching and videotape feedback, enable parents and children to practice communication, cooperation, and problem-solving skills. Evaluation results indicate that participants become successful in the home environment as a result of their involvement in the multiple-family, group-training sessions.     

Diagnosis of Fabry Disease via Analysis of Family History

Fabry disease is an X-linked lysosomal storage condition caused by a deficiency of α-galactosidase A. In order to determine the average number of family members who are diagnosed with Fabry disease following the diagnosis of a proband, four lysosomal storage disease centers across the United States reviewed the completed pedigrees of their Fabry disease patients. In addition, data from three Fabry disease families from other centers were submitted by patients directly. The pedigree review found 74 probands (54 males and 20 females) who had 357 diagnosed family members, of which 223 were female (60.5%) and 146 were male (39.5%). Analysis found that, on average, there were five family members diagnosed with Fabry disease for every proband. Now that enzyme replacement therapy (ERT) is available for the treatment of Fabry disease, this finding emphasizes the need for all health care professionals to ensure a detailed pedigree has been constructed for each patient affected by Fabry disease and to encourage testing and evaluation of all at-risk family members.     

Family systems psychiatry in an acute in‐patient setting: the implementation and sustainability 5 years after its introduction

From 2003 to 2008 a multicentre research project, systems therapy methods in acute psychiatry (SYMPA), attempted to establish structured in‐patient treatment based on systemic interventions in German non‐university psychiatric hospitals. Utilising multi‐professional family systems training for team members in six in‐patient wards, its main goal was to improve the involvement of familial and non‐familial important others. This follow‐up study explores the sustainability of family systems psychiatry by evaluating the frequency of the utilisation of four core systemic interventions; elements of a systemic organizational culture in psychiatry; and institutional barriers to this new approach. The degree of implementation was high to moderate, depending on the intervention. More intense communication developed among staff of different professions and the status of nursing staff improved. Organizational barriers to implementation included the ambiguous role of junior doctors in teams, continuously understaffed wards and frequent over‐occupancy.     

Informed consent in the psychosis prodrome: ethical,procedural and cultural considerations

Research focused on the prodromal period prior to the onset of psychosis is essential for the further development of strategies for early detection, early intervention, and disease pre-emption. Such efforts necessarily require the enrollment of individuals who are at risk of psychosis but have not yet developed a psychotic illness into research and treatment protocols. This work is becoming increasingly internationalized, which warrants special consideration of cultural differences in conceptualization of mental illness and international differences in health care practices and rights regarding research participation. The process of identifying and requesting informed consent from individuals at elevated risk for psychosis requires thoughtful communication about illness risk and often involves the participation of family members. Empirical studies of risk reasoning and decisional capacity in young people and individuals with psychosis suggest that most individuals who are at-risk for psychosis can adequately provide informed consent; however ongoing improvements to tools and procedures are important to ensure that this work proceeds with maximal consideration of relevant ethical issues. This review provides a discussion of these issues in the context of international research efforts.     

Systemische Therapien bei Menschen mit psychotischen Verhaltens- und Erlebnisweisen

Systemic therapy for persons who have been diagnosed as having schizophrenic or schizoaffective psychosis has been practiced since the 1950s, not everywhere and routinely but in many psychiatric hospitals and outpatient clinics with a strong psychosocial orientation. Evidence of the effectiveness is well documented in randomized controlled studies. This article describes three systemic approaches in which the authors are actively involved: (1) systemic constructivist family therapy developed in Heidelberg for outpatient contexts, (2) need-adapted treatment and open dialogue developed in northern Europe that has gained access to psychiatric clinics through regional training within integrated care projects and (3) the concept of systemic therapeutic methods of acute psychiatric treatment (SYMPA) a systemic family-oriented inpatient treatment.     

Quality and Individualization in Wraparound Team Planning

In children’s mental health, collaborative, team-based individualized service planning is most commonly known as wraparound, and has become one of the primary strategies for improving services and outcomes for children with the highest levels of need. We report on analyses of data gathered at 72 wraparound team meetings from communities around the United States. We describe the composition of the teams and the quality of the planning process they engaged in, and explore the extent to which these factors were associated with team member satisfaction and the individualization of plans. Teams in our study were numerically dominated by professionals. Parents attended a large majority of meetings, participation by youth and family advocates was frequent, participation by other family members infrequent, and participation by other members of the family’s informal or natural support networks rare. Observed teams varied considerably in the quality of their planning process and the degree of individualization of plans. Higher-quality planning was significantly associated with increased individualization of plans and with team member satisfaction with meeting productivity.     

Medical or relational language? Problem and goal formulation in family therapy with adolescents conducted in a psychiatric outpatient setting

The constructionist view assumes that therapy participants' maps of understanding depend on the institutional context and their personal perspectives. The purpose of this study was to investigate the initial maps of difficulties reported by family members starting family therapy. 106 families that were referred to a psychiatric institution for outpatient family therapy were asked open-ended questions regarding the context of the referral, and goal and problem formulation for the therapy. The data were analysed via the consensual qualitative research-modified (CQR-M) method, and comparisons between groups were performed. The obtained results show a diversity of perspectives. Of interest was the predominance of medical language in describing the problem and relational language in describing the goal of therapy. An analysis of differences between mothers, fathers, adolescent patient and their siblings was also performed. The findings highlight the complexity of notions that families start family therapy with and may help therapists navigate through the therapeutic contract formulation process.     

Creative Cognition and Psychosis Vulnerability: What’s the Difference?

Evidence from experimental psychology provides unequivocal support for enhanced creativity among individuals who are prone to psychotic and mood disorders. At the same time, there is strong epidemiological evidence for greater incidence of creative achievement among those diagnosed with bipolar disorder (but not schizophrenia). This review examines the evidence for common factors predisposing an individual to creativity and psychosis, as well as factors that distinguish the capacity for creative achievement from the creative potential that may be inherent in psychosis vulnerability. Factors implicated as common to creative potential and psychosis vulnerability include enhanced divergent thinking, reduced latent inhibition and preattentive filtering mechanisms; on the other hand, greater cognitive flexibility, motivation, and openness to experience tend to be associated with creative achievement, but not psychosis. This evidence is considered with respect to the utility of tailored vocational interventions to effectively harness creative potential, which may be useful for young individuals in the early stages of illness or their unaffected family members.