Evaluating family therapy: a comparison of the Milan and problem solving approaches

This paper describes a study comparing the Milan approach with problem solving family therapy. Twenty families were assigned to one of the treatments and data were collected assessing symptomatic (first order) and systemic (second order) changes. The results showed that families in both treatment groups achieved favourable changes in their presenting symptoms. Those families receiving the Milan approach showed a statistically significant improvement in second order changes compared with the problem solving group. Issues relating to treatment outcome, first and second order changes and methodology are presented.     

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.     

A meta-analysis of estimated effect sizes for group versus individual control treatments

A meta-analysis was conducted combining results from nine studies, using seventy-five outcome measures of 349 subjects. Only studies that contrasted group, individual, and control treatments with a pretest-posttest design were selected. Estimates of effect sizes were calculated for group, individual, and control treatments across all studies, according to treatment modality (psychotherapy, counseling, or psychoeducation), type of control (no treatment or some treatment), date of the study (1955-1969 or 1977-1982), and the subjects' age (adult, adolescent, or child). Results indicated that both group and individual treatments had a measurable effect that was consistently greater than that of controls. Further, (1) counseling produced much more of an effect than either therapy or psychoeducation; (2) the more recent treatments produced larger effects than the older studies; and (3) group treatments were more effective than individual methods in the treatment of adolescents, but were less effective in the treatment of children.     

Changing Concepts of Psychoanalytic Medicine Edited by Sandor Rado and George G. Daniels

A meta-analysis was conducted combining results from nine studies, using seventy-five outcome measures of 349 subjects. Only studies that contrasted group, individual, and control treatments with a pretest-posttest design were selected. Estimates of effect sizes were calculated for group, individual, and control treatments across all studies, according to treatment modality (psychotherapy, counseling, or psychoeducation), type of control (no treatment or some treatment), date of the study (1955–1969 or 1977–1982), and the subjects' age (adult, adolescent, or child). Results indicated that both group and individual treatments had a measurable effect that was consistently greater than that of controls. Further, (1) counseling produced much more of an effect than either therapy or psychoeducation; (2) the more recent treatments produced larger effects than the older studies; and (3) group treatments were more effective than individual methods in the treatment of adolescents, but were less effective in the treatment of children.     

Concomitant group therapy with anorectics and their parents as a supplement to family therapy

A study was made of family therapy with anorexia nervosa patients in a child psychiatric outpatient department. Eight families referred in 1984 were offered group therapy and family therapy simultaneously, one group for patients with anorexia nervosa and one group for their parents. The participants of both groups reported that they had learned a lot from the experience but stated that they felt group therapy could not replace family therapy.     

A comparative study of family therapy in the treatment of opiate users in a London drug clinic

This study presents the results of a randomized treatment trial of family therapy and two control treatments for 119 outpatient opiate users. All treatments were combined with a methadone reduction programme. The control treatments were: (1) a 'standard' treatment (supportive psychotherapy) and (2) a 'low contact' intervention. Treatment outcome was evaluated six and twelve months after the initial assessment. Both the family therapy and minimal intervention groups had a significantly higher number of drug–free days at six and twelve months, compared to the standard treatment, despite receiving fewer treatment sessions. Across all treatments there was evidence for a gender difference in response to therapy in users who were in a couple relationship. In couples where both partners were using drugs women did significantly better than men. Men living with a non–drug–abusing partner fared better than men living with a drug–using partner. Across the treatment groups diminution in drug use was accompanied by improvements in psychosocial functioning. Unemployment, sharing needles and injecting drugs were predictive of poor outcome.     

Methylphenidate and cognitive therapy: A comparison of treatment approaches with hyperactive boys

This study of hyperactive boys evaluated the effects of three modes of treatment in relation to an untreated group. The treatments were administered over a 3-month period and included cognitive training, stimulant drug therapy (methylphenidate), and the two treatments combined. A follow-up assessment was conducted approximately 3 months after contact between the training staff and the child had ceased. Analyses of attentional deployment and cognitive style measures, tests of academic achievement, and behavioral ratings showed that only those children in the two medication treatment conditions demonstrated improvement in attentional deployment and behavioral ratings. In the cognitive therapy condition, there were changes only on measures of attentional deployment. The data did not provide evidence indicating that the combined medication and cognitive therapy condition was any more effective than that condition involving medication alone. Discussion provides future guidelines for evaluation of the relative effectiveness of stimulant drug therapy and other psychological treatment modalities.     

Family therapy as a treatment for children: a critical review of outcome research.

The value of family therapy as a treatment for child psychopathology is considered by reviewing pertinent outcome research. Fourteen studies that met three criteria are included in the review: (a) a child or adolescent was the identified patient or referral; (b) therapy included at least one parent and the child; and (c) outcome was evaluated in terms of the child's symptoms. There are major shortcomings in most of the available data, with only two well-controlled studies. Some empirical evidence does exist that family therapy is an effective treatment for children; the data from studies of adolescents are especially encouraging. However, insufficient data are available for comparing the relative merits of conjoint family treatment and individual child therapy. If the value of family therapy as a treatment alternative or, ideally, as the "treatment of choice" for a referred individual child is to be established, more and better controlled comparative outcome studies will be necessary. Suggestions for future research are presented emphasizing the need for a developmental perspective by recommending, for example, the use of factorial designs in which the intervenaction of treatment and age can be analyzed.     

The Use of Time Limits in Brief Psychotherapy: A Comparison of Six-Session,Twelve-Session,and Unlimited Treatment with Families

This study compared the relative effectiveness of two durations of time-limited psychotherapy with time-unlimited treatment and a waiting list control group. Thirty-seven families applying for treatment at a child guidance clinic were randomly assigned to one of four treatment conditions: (a) time-limited therapy of 6 sessions within 8 weeks; (b) time-limited therapy of 12 sessions within 16 weeks; (c) time-unlimited therapy; and (d) a waiting list control group in which families waited approximately four months before beginning treatment. Outcome was assessed from multiple sources: parents, child, therapist, family interaction ratings, and missed and canceled sessions. Analysis of data provided some evidence that families who received treatment fared better than those on the waiting list. There were no consistent differences between 6-session, 12-session, and unlimited therapy. A model is proposed for the further investigation of time-limited treatment.     

A controlled trial of cognitive-behavioural and behavioural treatment of anorexia nervosa

This study was undertaken to investigate whether a cognitive-behavioural treatment procedure was superior to a standard behavioural treatment, in the outpatient therapy of patients with anorexia nervosa. The two treatments were also compared with a control treatment procedure consisting of routine outpatient management. Each group consisted of eight subjects. All the groups showed some improvement, but the findings did not provide support for the prediction that cognitive-behavioural treatment, designed specifically to manipulate both attitudes and behaviour, was superior to the other types of treatment. The implications of the findings are considered.     

Mother-blaming in family therapy: An empirical investigation

Abstract

This study tested two hypotheses derived from the feminist critique of family therapy in a sample of AAMFT members. The stimulus was a brief vignette of an initial therapy session with a family presenting a teen-aged child as the identified patient. It was hypothesized that family therapists would rate the mothers in the vignette as more dysfunctional than fathers. It was also hypothesized that mothers would be asked to bear more of the burden of change in treatment plans written by subjects. Neither hypothesis was supported. However, respondents did rate the concerned parent, regardless of sex, as more dysfunctional. Since this is a role often occupied by women, this finding may indicate some gender bias.     

The false consensus bias as applied to psychologically disturbed adolescents

In order to examine whether the false consensus bias applied to psychologically disturbed adolescents, outpatients at a rural mental health center who described themselves as very depressed or suicidal, and nondisturbed teenagers (who had no history of psychological treatment and were not at that time seeking psychological treatment), were asked to read a newspaper article about either a child's suicidal or viral illness death. Both groups of adolescents, like adults in previous research, viewed the suicidal child and the surviving family more negatively than they did the child and survivors of a viral illness death. Further, consistent with the false consensus hypothesis, adolescent clients viewed either child as more psychologically disturbed than did nonclients. Also, clients, as compared to nonclients, viewed both parents as more psychologically disturbed prior to either child's death. Results somewhat support the hypothesis of a false consensus bias which operates for depressed, suicidal adolescents when they view the tragedy of a child's death, but not when they are making recommendations about psychological help for the surviving family. Results are interpreted as suggesting that adolescent outpatients either view therapy as not particularly beneficial or as not particularly appropriate for bereaved individuals.     

Development of Family Therapy and Systemic Therapy in Germany

The roots of systemic therapy in Germany date back to the sixties. Systemic therapy is one of the most widely applied forms of psychotherapy and counseling in Germany. The majority of therapists and counselors in child guidance centers, couples therapy counseling centers and youth protective services have been trained in systemic therapy. A high number of clinical psychologists, social workers and medical doctors have received training in this model of therapy. In the beginning, multigenerational, experiential, as well as structural-strategic and Milan systemic approaches were popular. Today, the post-modern systems concepts, solution-oriented and narrative approaches and self-organization theory appear to be predominant. Some centers provide research and training in behavioral and psychodynamic family and couples therapy. However, systemic approaches are clearly leading the field with over 10,000 people who have received systemic training and about 150 training institutes across the country. The critical attitude shared by many leading figures towards empirical research has limited its success in university programs. In addition, training is usually provided in the form of post-graduate courses rather than at academic institutions. Currently, three journals and one online-journal publish articles on various systemic topics. Many publishing houses have a series of books on systemic therapy and one publishing house specializes exclusively on systems oriented books. In 2008, systemic therapy gained recognition as an evidence-based treatment. Four years later, the appropriate authorities have not initiated the process of assessing it as a treatment paid for by public health insurances. In consequence, systemic therapy is not available on a large scale in the public outpatient psychotherapy system. Some additional remarks are provided on the history and current situation of systemic therapy in Austria and Switzerland.     

Mind-Body Patterns of Symptom Generation

Effective ways for joining family therapy with other treatment modalities are becoming increasingly important as the efficacy of family therapy gains acceptance in the medical and mental health community. When one interfaces family therapy with medical and psychopharmacological treatments, which find the sources of symptoms within individuals, rather than interpersonal systems, careful attention must be paid to the mind and body relationships that guide interactions between family behavior and the somatic physiology of each family member. We present six mind-body patterns of symptom generation found to be particularly useful for designing multimodality treatments and for communicating the treatment rationale to medical and psychiatric clinicians or to family members. Case examples illustrate their clinical use.     

From Universe to Multiverses—and Back Again

A number of concepts and ideas from constructivist and second-order cybernetic family therapy literature are presented and their implications for therapy are examined. I was inspired by and, in this article, refer to videotapes of consultations and therapy sessions shown at an international conference on constructivism and family therapy in Sulitjelma, Norway, June 1988, and to written material from the Tromsø group Andersen and Anna M. Flå), the Milan team (Luigi Boscolo and Gianfranco Cecchin), and the Galveston team (Harlene Anderson and Harold Goolishian). The article also represents an attempt to use constructivist concepts and ideas in a reflection on the author's own professional development as a psychologist and family therapist.     

Sorrow,shame, and self-esteem: Perception of self and others in groups for women survivors of child sexual abuse

Despite evidence that exists about the severity of impact of child sexual abuse (CSA), less has been published about treatment options. Much CSA is enshrouded in secrecy in the context of dysfunctional family dynamics, therefore group work is often recommended as a method of treatment. Although long- and short-term groups are seen as being equally effective, there are few published studies of long-term analytic groups for survivors of CSA. This study was designed to analyse the process of one long-term group. A case is made for using Core Conflictual Relationship Theme (CCRT), a method designed to analyse individual therapy, with reference to group theory. Shifts in self-perception and in relation to others are analysed from the beginning to the end of therapy.     

Parenting and Family Stress Treatment Outcomes in Attention Deficit Hyperactivity Disorder (ADHD): An Empirical Analysis in the MTA Study

Parenting and family stress treatment outcomes in the MTA study were examined. Male and female (579), 7–9-year-old children with combined type Attention Deficit Hyperactivity Disorder (ADHD), were recruited at six sites around the United States and Canada, and randomly assigned to one of four groups: intensive, multi-faceted behavior therapy program alone (Beh); carefully titrated and monitored medication management strategy alone (MedMgt); a well-integrated combination of the two (Comb); or a community comparison group (CC). Treatment occurred over 14 months, and assessments were taken at baseline, 3, 9, and 14 months. Parenting behavior and family stress were assessed using parent-report and child-report inventories. Results showed that Beh alone, MedMgt alone, and Comb produced significantly greater decreases in a parent-rated measure of negative parenting, Negative/Ineffective Discipline, than did standard community treatment. The three MTA treatments did not differ significantly from each other on this domain. No differences were noted among the four groups on positive parenting or on family stress variables. Results are discussed in terms of the theoretical and empirically documented importance of negative parenting in the symptoms, comorbidities and long-term outcomes of ADHD.     

OUTCOME EVALUATION OF BEHAVIORAL PARENT TRAINING AND CLIENT-CENTERED PARENT COUNSELING FOR CHILDREN WITH CONDUCT PROBLEMS1

The central question addressed was, how effective is parent training in reducing conduct problems in children in comparison to client-centered parent counseling? A secondary question was the relative effectiveness of the two treatment groups in comparison to a wait control group that when untreated during the 8-week period of treatment provided the other groups. Families of 36, 5- to 12-year-old conduct problem children were screened and assigned at random to treatment groups, but wait control group assignment depended upon therapist availability. Supervised graduate student therapists conducted 10 treatment sessions for each family. Parent reports and paper and pencil tests of child deviance and parent satisfaction showed a superior outcome for behavioral over the client-centered and wait control groups, and no differences between the latter two groups. At follow-up there was no maintenance of this superiority. Home observation data showed no advantage of behavioral over client-centered treatment, and these two groups did not improve significantly more than the wait control group. These results were discussed in the light of possible interactions between treatment and measurement, and methodological and sampling differences between this and other studies.     

AN ALTERNATING TREATMENTS COMPARISON OF TWO INTENSIVE INTERVENTIONS FOR FOOD REFUSAL

We compared two treatment packages involving negative reinforcement contingencies for 3 children with chronic food refusal. One involved physically guiding the child to accept food contingent on noncompliance, whereas the other involved nonremoval of the spoon until the child accepted the presented food. Subsequent to baseline, an alternating treatments comparison was implemented in a multiple baseline design across subjects. After each child had been exposed to at least nine sessions of each treatment condition and percentage of bites accepted had increased to at least 80%, the child's caregivers selected the preferred treatment package. The results indicated that both treatments were effective in establishing food acceptance. However, physical guidance was associated with fewer corollary behaviors, shorter meal durations, and parental preference.     

Angststörungen und Phobien im Kindes- und Jugendalter

Anxiety disorders belong to the most frequent mental disorders in childhood and adolescence. They cause severe impairment, show poor long-term outcome and they are often not recognized as a mental disorder. For a reliable and valid diagnosis and treatment outcome evaluation a multi-informant approach is essential including information from the child and the parents. Methods of choice are structured clinical interviews and questionnaires filled out by the child and the parents. Meta-analyses showed that only cognitive-behavioral treatment can be considered as a sufficiently evidence-based treatment. No differences in outcome were found between individual and group treatments or child and family focused treatments. Medication treatment with selective serotonin reuptake inhibitor (SSRI) showed short-term efficacy. Major evidence-based interventions are psycho-education, exposure techniques and cognitive restructuring strategies.