Ethnic background, therapeutic alliance, and treatment retention in functional family therapy with adolescents who abuse substances

In this study, the authors examined the role of balance between adolescent-therapist and parent-therapist alliances in the retention of functional family therapy clients. Therapeutic alliances of mothers, fathers, and adolescents were assessed from videotapes of the 1st treatment session for 43 Hispanic and 43 Anglo families. Hispanic families who dropped out before completing the requisite number of sessions were found to have greater imbalance in alliance (parent-adolescent) than those who did complete therapy. However, this finding was not replicated with Anglo families. Results are interpreted in terms of previous research on family-level balanced alliance effects.     

Sandtray Therapy: A Familial Approach to Healing Through Imagination

The application of creative techniques in counseling is often tailored to a unique problem, and limited by individual characteristics of the client. One intervention, sandtray therapy, a derivative of play therapy, has gained strong momentum as a creative technique. With greater flexibility for treating a much larger population, sandtray therapy is more applicable for families than other creative approaches. The purpose of the current article is to give an overview of sand tray therapy, as well as provide information regarding its use for working with families. Specifically, the authors discuss exactly how counselors can successfully incorporate sandtray therapy in the familial population setting, and describe its application through case study.     

Examining the Role of Social Network Intervention as an Integral Component of Community-Based,Family-Focused Practice

Social network intervention aimed at bolstering the informal supports of high risk families is recognized as a common element of community-based, family-focused practice models, such as intensive family preservation services (IFPS), multisystemic therapy (MST), and the wraparound process. The empirical research basis for these practice models is examined, with an eye toward discerning the extent to which network intervention is identified as a critical component of comprehensive service. Results reveal that few studies make clear the degree to which treatment adhered to a focus on natural network enhancement or the development of informal resources. Those that did, suggest that relatively few families received this form of ecologically-oriented intervention. Consequently, this body of practice research offers insufficient evidence of the benefits or limitations associated with network facilitation with multi-need families. Explanations for these findings are explored and directions for future research are recommended.     

A Review of Family Therapy in Residential Settings

This article provides an overview of the history of family involvement in residential treatment as well as a synthesis of the research showing family-centered interventions and outcomes for youth in residential settings. There are many methods for engaging families in residential treatment that are discussed in the literature; however, there is a significant gap as the field has not yet identified specific family therapy approaches that demonstrate efficacy in working with youth and their families in this particular setting. A review of the literature over the past 10 years will highlight the emerging family therapy models being utilized in this setting, which include multiple-family group intervention, family-directed structural therapy, and narrative family therapy. The article will also include a discussion of three major, well-established theoretical approaches that have been found to be effective in working with youth with conduct issues and show promise in treating youth and families in the complex setting of residential treatment: brief strategic family therapy, multi systemic therapy, and functional family therapy.     

Low-Income Families With Potential Adolescent Gang Involvement: A Structural Community Family Therapy Integration Model

The purpose of this article is to propose a community structural intervention for low-income families who present to therapy with the concern of an adolescent at risk for gang involvement. Families are affected by multiple interacting systems. In congruence with systems theory, changing a part of the system will essentially affect the interrelated parts of the system. The proposed intervention utilizes structural family therapy and community family therapy as a model to impact change at the family system, its interrelated systems, and the system at which the family is embedded.     

Research as a family therapy intervention technique

The utilization of the research process as an intervention has recently been described in the family therapy literature. However, it is important to draw a distinction between research as intervention and research as a unique family therapy intervention technique. From a family systems perspective, research as an intervention technique may make therapy more palatable for some families. A case study is presented in which this technique created the context for change for a family involved in a chronic illness research project.The author would like to thank Dr. Wendy L. Watson for her participation as a member of the clinical team and Drs. Fabie Duhamel and Wendy L. Watson for their helpful critiques on earlier drafts of this paper.Supported by a grant from the Albert Foundation for Nursing Research.     

Brief Strategic Family Therapy: Twenty-Five Years of Interplay Among Theory, Research and Practice in Adolescent Behavior Problems and Drug Abuse

This article describes a systematic program of research that focuses on Brief Strategic Family Therapy (BSFT) and the adaptations that were developed based on BSFT principles. The culture-specific origins of BSFT are reviewed, as well as its broader applications to the field of family therapy. Research is reviewed demonstrating that BSFT is a promising family-based approach to treating Hispanic youth behavior problems and drug abuse. Treatment innovations are described that address the combination of intergenerational and cultural differences that occur among youths and their Hispanic parents. Programmatic work is described that challenges basic principles of family therapy by expanding BSFT to a One Person modality and a strategic engagement procedure. Both of these novel approaches are intended to add tools to therapists' repertoire in working with difficult-to-engage families. A preview discussion of results is presented from a randomized clinical trial that is an application of an ecosystemic prevention version of BSFT. The implications of the work of the Center for Family Studies are discussed in the context of the broader service system. Ultimately, this article articulates a way of thinking about adolescent problem behavior, its social interactional determinants, and a range of theoretically consistent family-centered strategies that attempt to change social ecological processes that impact adolescent developmental trajectories.     

Perceptions of Stress,Coping, and Intervention Preferences among Caregivers of Disadvantaged Children with Asthma

Asthma remains the most prevalent chronic illness among children. Despite the substantial body of literature examining children with asthma, few studies have examined parents’ perspectives of the condition and experiences of caregiver stress. Parents of children with chronic illnesses experience elevated stress and may have limited opportunities to cope with complex emotions while caring for children with asthma. Drawing from focus groups and interviews with African American and Hispanic parents of children with asthma, this qualitative study was conducted as part of a patient-centered engagement process to inform the refinement of an intervention aimed at reducing stress among parents of children with asthma. All data were transcribed and underwent three waves of inductive analysis. The content analysis indicated that the unpredictable nature of asthma and the caregiving burden associated with managing children’s asthma contributed to parents’ stress, and external contexts compounded the impact of these stressors. Parents also reported having difficulty identifying how they coped with stress and employed approaches to coping with stress that they applied intermittently but encountered several barriers to enacting known or available coping strategies. Analyses also revealed that parents desired a multimodal stress reduction intervention that emphasized building relationships, allowed for flexibility, and encouraged staff-parent communication. Whereas African American and Hispanic parents’ experiences of stress and coping strategies were similar, their preferences differed in regards to incorporating technology into the intervention, the credentials of facilitators, and the salience of language preferences. Understanding the complexities of stressors facing caregivers is important for developing interventions to support parents and children coping with asthma, and in particular when working with families from diverse backgrounds.     

Marital conflict, family processes, and boys' externalizing behavior in Hispanic American and European American families

Used self-report and observational measures to explore associations among marital conflict, triadic family processes, and child adjustment in Hispanic American, European American, and biethnic families. One hundred and thirteen families with a 7- to 11-year-old son participated. More similarities than differences were found between European American and Hispanic American families. A hierarchical parenting style was associated with externalizing behaviors for European American and biethnic families but not for Hispanic American families. Marital conflict and disengaged family alliances were associated with child externalizing behavior for all ethnic groups. Ethnicity was not found to moderate the relation between marital conflict and family functioning, and greater levels of marital conflict were associated with disengaged family interactions and also with lax or inconsistent parenting. Implications for understanding cross-ethnic issues in family systems and child adjustment are discussed.     

Reducing the Risk of Internalizing Symptoms among High‐risk Hispanic Youth through a Family Intervention: A Randomized Controlled Trial

Familias Unidas is an intervention that has been found to be efficacious in preventing and reducing substance use, sexual risk, and problem behaviors among Hispanic youth. While it does not specifically target youth internalizing symptoms, the intervention works to strengthen parenting and family factors associated with reduced risk of internalizing symptoms (i.e., depression, anxiety symptoms). This study examines the effects of Familias Unidas on internalizing symptoms among high‐risk youth, as well as the role of family level factors in the intervention's effects. A total of 242 12–17‐year‐old Hispanic youth with a history of delinquency and their primary caregivers were recruited from the school and juvenile justice systems, and randomly assigned to the Familias Unidas intervention or community practice control. A linear latent growth model was used to examine intervention effects on the trajectory of adolescent internalizing symptoms from baseline to 6 and 12 months post‐baseline. Results show that the Familias Unidas intervention was more efficacious than control in reducing youth internalizing symptoms. Baseline youth externalizing and internalizing symptoms did not moderate the intervention's effects on the trajectory of youth internalizing symptoms. While parent – adolescent communication did not significantly moderate the intervention's effects, changes in parent – adolescent communication mediated the intervention's effects on internalizing symptoms, showing stronger intervention effects for youth starting with poorer communication. Findings indicate that the Familias Unidas intervention can reduce internalizing symptoms among high‐risk Hispanic youth, and that improving parent – youth communication, a protective family factor, may be one of the mechanisms by which the intervention influences youth internalizing symptoms.     

Group therapy with inner city hispanic acting-out adolescent males: Some theoretical observations

Group therapy with inner city Hispanic acting-out adolescent males is described as an effective psychotherapeutic modality in treating this difficult population. Topics addressed include the development of personality during adolescence, Hispanic family dynamics and gender roles, group therapy as a pseudofamily structure, stages of group development as they pertain to this population, and the group therapist's role and characteristics in the treatment situation.     

Family Functioning, Identity, and Problem Behavior in Hispanic Immigrant Early Adolescents

The present study investigated the role of identity in the relationship between family functioning and behavior problems in a sample of Hispanic immigrant early adolescents and their families. The sample consisted of 181 Hispanic immigrant adolescents (92 males, 89 females) and their participating caregivers (who were mostly mothers). Identity was measured using adolescent reports, whereas family functioning and early adolescent behavior problems were measured using both adolescent and parent reports. Correlational analyses indicated that previously obtained relationships among family functioning, identity, and behavior problems were replicated in the present sample. Structural equation models indicated that 20% of the relationship between family functioning and behavior problems operated indirectly through identity, and identity confusion partially mediates the relationship between family functioning and early adolescent behavior problems. Implications for intervention are discussed.     

Teenage depression: a cultural-interpersonal-intrapsychic perspective

The "crossroads families" are caught between old value systems and American mainstream goals. Traditional family and sex-related roles and orientations conflict with those of the new social system. In turn, neither of the teenager's orientations--toward home or toward peer activity--is validated. In the clinical case presented, Anna, at adolescence, wants to relinquish many of her household chores and enter her social world more fully. She needs unconflictual support for such a move. If this does not take place, her autonomous movement represents an unconscious betrayal of her depleted and controlling mother as well as an abandonment of the parental coalition. This leaves her feeling resentful, guilty, and ultimately unlovable. Attitudes marked by helplessness and confusion are thus significant to the depressed affect that brings this teenager into family therapy. Teenagers of non-Hispanic background who enter family therapy reveal gross overlap with teenagers of the Hispanic "crossroads" family model. Here, the family gives mixed messages for homebound and intimate closeness as well as accomplishment in the societal mainstream. A primary difference between ethnic groups involves the freer expressions of anger and pain between husband and wife in the non-Hispanic families. This is not similar to the backgrounds of the more individuated Hispanic teenagers. While more open expressions of anger within the family do indicate higher levels of autonomy, the hostility that is expressed by the parents presents serious complications when this includes "triangulating" the child into the family tension. Here, as cited, the mother often uses her daughter as a confidant and ally at times of severe parental discord. This places additional strain on the child's conflict with separation. Importantly, the daughter experiences renewed rejection and betrayal when the mother "submits" to her spouse. These are significant family processes that heighten mixed messages around autonomy. Milagros, a depressed (more individuated) adolescent, is consistently entangled into her parent's abrasive relationship. Her interpersonal family struggles have become intrapsychic and, ultimately, transferential.     

The evolution of family interventions for schizophrenia. A tribute to Gianfranco Cecchin

Family intervention for schizophrenia has informed the whole history of family therapy, although in different fashions. This presentation will deal with the main phases of such intervention, outlining the characteristic features of each one. We can roughly divide the history of family intervention for schizophrenia into four phases: Phase 1 – Conjoint family therapy (1955–1965). Family interventions were aimed at modifying family communication patterns, implying the possibility of a definitive resolution of psychopathology. Phase 2 – Antipsychiatry (1965–1975). This, rather than a treatment model, was a philosophy of psychiatry, which considered schizophrenia as an epiphenomenon of the distortions of Western society. Family treatment was aimed at promoting the awareness of such a dynamic. Phase 3 – Milan systemic therapy (1975–1985). The systemic model was aimed at helping people with schizophrenia to recognize their position within their families (and other significant systems), giving all family members a new sense of their relationships to each other. Phase 4 – Psychoeducation (1985–2005). In most psychoeducational models, schizophrenia was conceived of as a biologically determined disorder. Psychoeducation was a way of helping the not diagnosed family members to cope with problems brought about by the illness, eliciting consensus towards psychiatric treatments such as medication and rehabilitation. A fifth phase of family intervention for schizophrenia is probably developing right now. If this is happening it should probably be an integrative phase, in which different approaches to family dynamics might be bridged and blended, in order to give more effective help to all members of families with schizophrenia.     

Working with Bangladeshi families in the East End of London

This paper is an account of the author's evolving practice in working with Bangladeshi families in the East End of London. It considers first of all the circumstances of such families: their socio-economic situation, and their beliefs about family life, mental illness and seeking help. Then it describes two case examples illustrative of those styles of working and techniques of intervention from different family therapy approaches which have proven most applicable to working with families from this community.     

Treatment of families during life transitions: matching treatment to family response

This article examines the conceptualization and treatment of families during normative and non-normative life transitions. Variables identified by individual and family developmental theorists account for some variation in responses of families to life transitions. Three family variables are identified as critical to practitioners' understanding of families: disruption of time schedules, number of new decisions involving initial disagreement, and pretransition family conflict. Different responses are hypothesized for families high or low on each variable. Six treatments of families are identified: historical family therapy, structure/process family therapy, experiential family therapy, psychoeducational approaches, family crisis intervention, and enrichment. The likelihood of success of each treatment is predicted on the basis of a family's response to the transition.     

阿尔茨海默病的非药物干预与照料

目前阿尔茨海默病尚无根治性的治疗方法,药物治疗基本上是针对临床症状的对症治疗,只能在一定时期内起到改善或延缓疾病发展的作用。非药物治疗包括心理、社会、环境等综合干预,通过多重感官刺激、身体和智能锻炼、芳香治疗、感觉刺激、个性化音乐等方法,配合药物治疗以期尽可能长地保持阿尔茨海默病患者的功能水平,延迟日常生活能力的下降,减轻照料者负担,从而改善阿尔茨海默病患者及其家属的生活质量。对照料者的培训是非药物治疗的重要环节,照料的质量直接影响患者及家属的情绪和生活质量。     

Substance Abuse,Familial Factors,and Mental Health: Exploring Racial and Ethnic Group Differences Among African American,Caucasian, and Hispanic Juvenile Offenders

The present study examined racial, ethnic, and gender differences in family composition substance abuse, and mental health issues, such as depression and self-esteem among adjudicated juvenile offenders. Results revealed a negative relationship between depression and self-esteem among all ethnicities and family compositions. Caucasians reported greater incidence of substance abuse than did African American and Hispanic youth. Moreover, in reconstituted families, Caucasians had lower self-esteem scores than did other ethnicities. The findings illustrate the complexities of risk to substance use among high-risk populations, particularly as they relate to familial factors and the importance of intensive family therapy among this population.     

Adaptation of a behavioral parent‐training curriculum for Hispanic caregivers: HOT DOCS Español

This article presents the process utilized to adapt a behavioral parent‐training curriculum for Hispanic caregivers from a program currently available in English. Throughout this process, a number of cultural and language elements were identified as needing to be modified to meet the needs of the Hispanic population served. Fidelity and fit were balanced to develop a curriculum acceptable to diverse Hispanic caregivers while also incorporating all the essential elements of a theory‐based approach to training caregivers. The lessons learned from this adaptation may assist others in their attempts to meet the needs of Hispanic families.     

Breathing life into family processes: introduction to the special issue on families and asthma

This introduction to the special issue dedicated to families and asthma proposes that the study of asthma highlights general systems topics such as integration of individual needs into the group, developmental trajectories of risk and resilience, supportive and destructive patterns of interaction, and the cultural adaptation of family therapy. It briefly introduces papers in the special issue and concludes that asthma can serve as an exemplar in the study of family health due to its comorbidity with mental health problems, potential to affect multiple members of the family, disproportionate influence on low-income and minority families, and multiple avenues for intervention.