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.     

Brief strategic family therapy: lessons learned in efficacy research and challenges to blending research and practice

In this article, we present key lessons that we have learned from (1) a long program of research on an empirically supported treatment, brief strategic family therapy (BSFT), and (2) our ongoing research and training efforts related to transporting BSFT to the front lines of practice. After briefly presenting the rationale for working with the family when addressing behavior problems and substance abuse in adolescent populations, particularly among Hispanic adolescents, we summarize key findings from our 30-year program of research. The article closes by identifying barriers to the widespread adoption of empirically supported treatments and by presenting current work within the National Institute on Drug Abuse's Clinical Trials Network that attempts to address these barriers and obstacles.     

Order effects in sequentially judged options due to the direction of comparison

Many real-world judgment tasks present options in sequence. Typically, these judgments are made step-by-step, immediately after considering each option, or end-of-sequence, after all have been seen. We report similar order effects in both procedures, due to direction of comparison. It appears that judges form an impression of each new option by comparing it to those that preceded it. Using that option’s features as a “checklist,” more weight is given to unique ones than to ones shared with previous options. This unidirectional comparison process produces increasing ratings in options with unique positive features, and decreasing ratings when options have unique negative features. By manipulating the barriers to making multiple comparisons, we show that the direction-of-comparison effect is not limited to judgment tasks with sequential presentation. Even simultaneously presented options may show order effects, if they are judged one at a time—in sequence. Possible explanations and implications are discussed.     

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.     

Application of family therapy theory to complex social issues: using the WebQuest in family therapy training

This paper describes how the WebQuest is used to foster critical thinking and application of theory to complex social problems in a Master's level class on contemporary family therapy theories. The issue of child trafficking and prostitution is explored through the web‐based inquiry learning where scaffold learning is provided. Scaffolding includes resource links and guidance on cognitive and social skills, which are provided to facilitate the learner's development. The WebQuest design includes the task, the process and the evaluation rubrics. Student feedback on the WebQuest was positive and included increased motivation in learning, critical thinking and global awareness.     

Reductions in criminality subsequent to group, individual, and family therapy in adolescent residential and day treatment settings.

The complete population of adolescents in a residential and day-treatment program over a 4-year period, 532 youths, served in two studies. Along with residential and day-treatment settings, predictive variables of interest were the number of hours spent in group, individual, and family therapy. A total of 227 adolescents qualified for Study 1 which found a reduction of rates of criminal charges from pre- to posttreatment. Study 1 also found that hours in group therapy explained the most variance in the reduction in rates of criminal charges, followed closely by hours in individual therapy. Hours in family therapy was not a significant predictor. A total of 430 adolescents qualified for Study 2, which found that residential treatment was associated with greater reductions in adult correctional commitments than day treatment. Implications stress the need for further research examining the relationships between therapeutic components of residential treatment and behavioral outcomes.     

Deficits on the Continuous Performance Test within the schizophrenia spectrum and the mediating effects of family history of schizophrenia

Individuals with schizophrenia spectrum personality disorders (SSPD) and schizophrenia show similar cognitive impairments. The authors examined the contributions of SSPD symptoms and familial risk for schizophrenia to impairments on the Continuous Performance Test--Identical Pairs Version. Participants included 103 schizophrenia patients, 66 first-degree relatives (29 SSPD), and 103 community controls (26 SSPD) screened for family history of psychosis. Patients and SSPD relatives performed significantly worse than non-SSPD relatives and SSPD and non-SSPD community controls. No differences in performance were observed among non-SSPD relatives and SSPD and non-SSPD community controls. Results suggest a continuum in which risk for schizophrenia-related cognitive impairments is highest among patients and SSPD relatives, intermediate among non-SSPD relatives, and lowest among SSPD and non-SSPD community controls. Results suggest that SSPD in the absence of a family history of psychosis may be a phenocopy.     

Influences upon willingness to participate in schizophrenia research: an analysis of narrative data from 63 people with schizophrenia

Schizophrenia affects more than 1% of the world's population, causing great personal suffering and socioeconomic burden. These costs associated with schizophrenia necessitate inquiry into the causes and treatment of the illness but generate ethical challenges related to the specific nature and deficits of the illness itself. In this article, we present a systematic analysis of narrative data from 63 people living with the illness of schizophrenia collected through semistructured interviews about their attitudes, beliefs, and experiences related to psychiatric research. In the comments of these individuals, half of whom had had prior personal experience in research protocols, we identified factors influencing openness toward research involvement as well as deterrents that appear to lessen interest in participation. Clear response pattern differences emerged between those with prior research experience and those without such experience. In the discussion, we explore the key findings and outline the implications for safeguards in mental illness research.     

Too close for comfort: the impact of dual relationships on group therapy and group therapy training

The healing power of psychodynamically oriented therapy and training groups rests, to a large degree, upon the quality of the here and now interactions. For the work to be effective, the basic principles of analytic group work need to be followed, including the observance of no extra-group contact. Simply said, nothing leaves the room. This principle has both ethical and clinical implications. It is my premise that while some forms of outside contact between members are relatively benign, other types are not. Outside contact that is built into the fabric and context of the group may pose a risk, as may be the case where dual relationships exist between members. The impact of dual relationships between group members in the particular instance of analytic training institutes is the focus of this article. What happens to the transference in this context when members reveal too much of their personal lives to each other through dual relationships is explored. It is suggested that extra-group contact can disrupt the balance between reality and transference distortion in group interactions in at least three ways: (a) "The Emperor's New Clothes" effect, (b) looping, and (c) gaslighting. Vignettes are presented to illustrate these phenomena and suggestions for reform are offered.     

Consistency in individual and family theoretical orientation from assessment to therapy: Its impact on the effectiveness of therapy

Abstract

The effect of consistency in theoretical orientation, whether individual or family, from assessment to therapy on the effectiveness of psychotherapy was examined in archival data. All identified patients (N=131) were ages 5-18 and comprised four groups according to the orientation of their assessment and therapy: the individual-individual (n=49) and family-family (n=49) groups and the individual-family (n=21) and family-individual (n=12) groups. Theoretical consistency was positively associated with therapy duration and participation, as well as with outcome. This association was attributable to the significant relation between family assessment prior to family therapy and the dependent variables of continuation in therapy, percent of sessions attended, nature of termination, and percent of missed sessions. Results support the theoretical position of family therapists that family assessment is the assessment method of choice.     

Using group therapy to foster the psychosexual development of patients with eating disorders

When eating-disordered patients participate in long-term eating-dis-order groups, they move through phases of group development that parallel phases of psychosexual development. In the trust (oral) phase, members have an opportunity to experience a positive symbiosis, a suitable holding environment, and optimal frustration. In the control (anal) phase, members learn to identify and express anger constructively. In the intimacy (oedipal) phase, members learn to compete and be intimate. Individual and group movement is facilitated by the group leader being able to identify stages of group development and being able to utilize phase-related techniques.Many thanks to Anne Alonso, Ph.D., Robert Dies, Ph.D., and Geraldine Alpert, Ph.D., for their critiques of the first draft of this paper.