Toward an integration of child and family therapy

Current forms of treatment for the symptomatic child are reviewed and analyzed. There are four general approaches to treatment: individual child psychotherapy, conjoint parent-child psychotherapy and counseling, parent therapy and counseling, and conjoint family therapy. Each approach has certain strengths, but in-and-of itself is an incomplete treatment mode. An integration of child and family therapy is recommended, and recent attempts at this integration are described. These include approaches which work within the framework of conjoint family therapy and those which provide concurrent child and family therapy.     

The centrality of values in families and family therapy

Values are discussed in terms of development, nature, and implications for family therapy. Clinical examples are used to demonstrate concepts and a model is presented which depicts how the various leverages utilized in family therapy relate to family values. Individual development, cultural heritage (legacy), the nuclear family system, and the contemporary context are described as factors which interact to form values. A case is made for conceptualizing values as central to family therapy relative to engaging families, intervening in families, and evaluating therapeutic impact.     

A responsibility model for the practice of professional school psychology: Psychoeducational therapy

This paper discusses from first-hand experience the need for, and development of, a program of psychoeducational therapy within a school system. Conditions in the schools that support and influence the therapy, as well as therapy characteristics, are considered in some detail. Reasons are delineated that make this a responsibility model of school psychology practice. The therapy program is part of a larger supporting thrust in intervention, features of which are briefly referred to.     

归因疗法——一种重要的心理治疗方法

归因疗法是心理治疗的重要方法之一。迄今为止 ,人们已经发展了运用归因理论于治疗实践的两种一般模式 :“真归因疗法”引导患者用准确的归因代替错误的归因 ,“误归因疗法”引导患者用不准确而有益的归因代替准确而有害的归因。归因疗法受到了其他心理治疗理论的怀疑和批评。     

认知行为治疗的生物学机制

现阶段认知行为治疗的生物学机制尚不明确。本文将从脑功能、神经电生理、神经内分泌与免疫以及遗传与表观遗传这四个方面对认知行为治疗的生物学机制进行讨论, 综合心理、生理和遗传三方面的结果, 从微观、中间和宏观多层面提出了认知行为治疗生物学机制的整合模型。并进一步对目前研究的局限性进行了讨论, 为未来探究认知行为治疗的生物学机制提供了新的方向。     

Views on REBT,Past, Present and Future: Albert Ellis’ Contribution to the Field

This article demonstrates how REBT has changed over time in terms of what is considered to be an irrational belief, in particular how the concept of an irrational belief has been narrowed down. REBT is more of a goal oriented therapy as opposed to a cognitive therapy, and is referred to as an intentional therapy. The ways in which one can dispute irrational beliefs intellectually and in a more dynamic way are demonstrated. Attention is given to the provocative and confrontational way Albert Ellis did therapy, which was not generally appreciated by the public but also not appreciated by some REBT therapists. Reasons why people may dislike such a way of doing therapy are addressed. Some of the weaknesses of REBT are discussed and recommendations are made to address these weaknesses.     

Maps and mapmaking: Developing the systemic paradigm of family functioning

This paper presents the Systemic Paradigm of Family Functioning (SPFF) as an organizing framework for integrating models of family therapy. Therapists can use the SPFF to understand and integrate existing models of family therapy and to create their own personal models of family therapy. The SPFF framework highlights the interrelationships among the four generic models which dominate the field of family therapy. Personal models of family therapy are based on maps of family functioning derived from one of these more generic models.     

Theorizing About Power: Intersecting the Ideas of Foucault with the “Problem” of Power in Family Therapy

How to theorize about power has been a controversial issue in systemic family therapy, which, in its understanding of power, has shown the legacy of Gregory Bateson's ideas in terms of its earlier censorship of the concept of power as well as in the way in which the more recent challenges continue to be framed in relation to Bateson's position. This essay examines the work of the French philosopher, Michel Foucault, and his ideas on power in relation to family therapy themes. The main aim in intersecting Foucault's ideas with the “problem” of power in family therapy is to shed a different light on the way in which family therapy has theorized about power. A strong point of connection is made between Foucault's commitment to a relational analysis of power and family therapy's commitment to recursive analysis. However, a number of major contrasts are also identified. These contrasts are used to underline the need for family therapy to abandon the restrictions of Bateson's ideas on power, and to tackle the task of developing and using a recursive understanding of power.     

Systems and Solutions: The Discourses of Brief Therapy

The author describes how brief therapy has evolved in the past 10 to 15 years from ecosystemic to solution-focused brief therapy. SFBT is characterized as a radically constructivist approach to personal problems which emphasizes how troubles and solutions are socially constructed realities.     

Uncommon strategies for a common problem: addressing racism in family therapy

Race and racism have a profound effect on our daily lives and the practice of family therapy. Whether individual or institutional level, overt or covert, intentional or unintentional, there are a variety of ways in which racism can infiltrate the therapeutic process. Before therapists can take steps to address racism effectively within the context of family therapy, it is important to attend to the development of their racial awareness and racial sensitivity. These provide the critical foundation upon which specific skills and strategies associated with effectively identifying and responding to racism in therapy are based. This article defines racial awareness and sensitivity and provides suggestions for enhancing both. In the section that follows, three major ways in which racism can infiltrate the therapeutic process are described. Skills and strategies for addressing each of these in family therapy are presented.     

An empathy-humility-commitment model of forgiveness applied within family dyads

Forgiveness is described as requiring empathy for the offender, the humility to see oneself as being as fallible and needy as the offender, and courage to commit publicly to forgive. Research supports the model in individual therapy and psychoeducational groups in which the forgiver does not have to confront the offender. Family therapy, in which partners, parent–child dyads or siblings must confess their need for forgiveness and forgive face to face provides special challenges. Processes of forgiveness – empathy, humility and commitment – are understood to be the same as in any interpersonal forgiveness context; that is, they are thought to occur within dyads. Techniques compatible with several varieties of family therapies are summarized for applying the model in family therapy to encourage family members to forgive.     

Effectiveness of Couple Therapy in Practice Settings and Identification of Potential Predictors for Different Outcomes

Even though couple therapy is efficacious, there is no improvement in up to 50% of the couples. Also effect sizes found in effectiveness studies in real-world settings are considerably lower than those found in efficacy studies. There is a need to understand more about couple therapy effectiveness in practice settings and the factors responsible for different outcomes. A German nationwide study on the effectiveness of couple counseling including 554 couples applied the same methodology as two earlier studies in the same field. A remarkable consistency was found over the three independent studies in the burden with individual and relationship distress as well as in the rates of improvement. This supports the insight that the improvements reached through couple therapy in practice settings are only about half of the effect sizes reached in efficacy trials. Additionally this study investigated 64 factors, which were found to be influential for relationship quality and stability in earlier studies, for their impact on outcome. Factors present at initiation and termination of therapy were found, which correlate significantly with outcome and with separation of the couple in the follow-up. These factors could be included in prediction models for improvement and separation of the couple. The implications for the practice of couple therapy and for future research are discussed.     

Wie wirksam sind psychoanalytisch orientierte Therapie und Verhaltenstherapie bei Persönlichkeitsstörungen?

This meta-analysis adresses the effectiveness of psychodynamic therapy and cognitive-behavioral therapy in personality disorders. Included were 14 studies of psychodynamic therapy and 11 studies of cognitive-behavioral therapy from 1974 to 2001. There is evidence that both psychodynamic therapy and cognitive-behavioral therapy are effective treatments of personality disorders. As the number of studies that could be included in this meta-analysis was limited, the conclusions that can be drawn are only preliminary. Further studies which examine specific forms of psychotherapy in specific types of personality disorders using criteria of core psychopathology are necessary. Both longer periods of treatment and follow-up studies should be included.     

Revenge of the mutant cockroach: culturally adapted storytelling in the treatment of a low-income African American boy

A clinical case is presented in which a culturally adapted storytelling technique was used in child therapy with a socioeconomically disadvantaged African American boy. In this intervention, the child and therapist co-created a story by taking turns adding to the story during therapy sessions. The child's contributions to the story were interpreted by taking into account his sociocultural context, and the therapist's responses were adapted to reflect relevant sociocultural factors. Advantages of storytelling techniques in child therapy are presented, and issues to consider when using these techniques with culturally diverse populations are discussed.     

A structured approach to disengagement in family therapy with child-focused problems

The aim of this paper is to describe a structured approach to managing the disengagement process. Six distinct disengagement scenarios are first outlined. Thereafter, phasing out therapy, dealing with family belief systems concerning the permanence of improvements and relapse management are discussed. Ways in which disengagement from specific episodes of therapy may be construed as part of an ongoing therapeutic relationship and the practicalities of recontracting for further episodes of therapy, handing over cases, and referring cases on to other professionals are considered. An approach to therapeutic failure analysis is presented. Finally, ways in which disengagement may lead to significant loss experiences are discussed.     

Stationäre körperbezogene Psychotherapie bei Anorexia und Bulimia nervosa

Disturbances of body-images in women with anorexia and bulimia nervosa are described at the behavioral, perceptional and affective-cognitive level. The disturbances of body image, which are often accompanied by personality-structural deficits and have a decisive influence on the course of disease, can be reached only in part by verbal forms of therapy. Considering these facts, we present an integrative clinical procedure in which the application of body-related therapy modules play a central role in supplement to cognitive-behavioral and psychodynamic forms of therapy. Process-oriented body-perception therapy in an individual setting and a communicative movement group therapy are used and their relevance to the in-patient therapy process examined from the patient’s point of view. The study reveals a high value of body-psychotherapy, wherebydifferences were observed between anorexia (15) and bulimia (27) patients in the course of the process. The results suggest an indication for the application of combined individual and group body-psychotherapy for hospitalized anorexia patients. A communicative body therapy in group form is also very important in the in-patient treatment of bulimia patients, but there is a differential indication with regard to individual body therapy.     

儿科重症监护室中放弃治疗的相关问题研究

随着现代伦理学、生命质量和生命价值理论的发展,对于儿科重症监护室中部分病情危重且不可避免地将出现影响其远期生存质量的后遗症的患儿来说,选择放弃治疗可能更符合伦理学及患儿的最佳利益。对儿科重症监护室中部分患儿放弃治疗的实施过程、必备条件、常见原因、实施对象、相关伦理学及法律问题进行了探讨,以求为临床诊疗提供理论参考。     

论中医的辨证论治与肿瘤的分子靶向治疗

辨证论治是中医认识和治疗疾病的基本原则,“同病异治”和“异病同治”是辨证论治的精神实质。恶性肿瘤的分子靶向治疗在很多方面都贯彻了“辨证论治”观念,将所辨的证候落实到受体、基因和各种调控系统上。尽管两者理论基础完全不同,但都强调以患者为中心的综合治疗和个体化治疗理念,对建立正确的临床思维非常重要。     

Child and adolescent psychotherapy outcomes in experiments versus clinics: Why the disparity?

In a recent article, Weisz, Weiss, and Donenberg (1992) compared the effects of child and adolescent psychotherapy in experimental studies and in studies of clinic practice. Here we update that report with new information and we explore 10 possible reasons why, to date, therapy in experiments appears to have shown larger effect sizes than therapy in clinics. We find that beneficial therapy effects are associated with three factors which are more common in research therapy than in clinic therapy: (a) the use of behavioral (including cognitive-behavioral) methods, (b) reliance on specific, focused therapy methods rather than mixed and eclectic approaches, and (c) provision of structure (e.g., through treatment manuals) and monitoring (e.g., through review of therapy tapes) to foster adherence to treatment plans. These three factors all involve dimensions along which clinic procedures could be altered.