Family Centred Brief Solution-focused Therapy with Chronic Schizophrenia: a Pilot Study

The purpose of the study was to pilot a family centred brief solution-focused therapy model (BSFT) with families and clients diagnosed with schizophrenia. A control group of clients and their families received traditional outpatient therapy, while an experimental group of clients and their families were treated with a BSFT model. All participants were pre-tested and then post-tested with the Family Environment Scale after five therapy sessions over a ten-week period. Significant differences between the groups were found on expressiveness, active-recreational orientation, moral-religious emphasis and family incongruence. The participation of families and clients with schizophrenia in family centred brief solution-focused therapy produced encouraging results and demonstrated the need for expanded studies using BSFT with other chronically mentally ill clients and their families.     

Researching the Family Theories of Schizophrenia: An Exercise in Epistemological Confusion

Some, but not all, of the family theories of schizophrenia entail a shift from the Aristotelian/Cartesian/Newtonian epistemology of individual psychology to a systemic epistemology of pattern. Perhaps the most significant (and underappreciated) aspect of this epistemological shift pertains to etiology: The family theories of schizophrenia espoused by Bateson et al. and by Wynne and Singer do not claim that parents or families cause schizophrenia. The persistent failure of researchers to appreciate this has led to many fruitless studies that have sought to discover a causal link between the thought disorder and communication deviance of parents and the schizophrenia of their offspring. This paper reviews from an epistemological viewpoint the empirical literature that has attempted to assess the validity of the family theories of schizophrenia. Particular attention is given to restating and extending the epistemology of pattern within which schizophrenia occurs. The conventional psychiatric approaches to schizophrenia are shown to play an active role within the schizophrenic pattern.     

A Method of Co-Therapy for Schizophrenic Families

This paper describes a model of treatment for families in which one child has been given the diagnosis of schizophrenia. Male and female therapists adopt structured roles that are used as a paradigm for exploring family patterns. The paradigm employs a three-generational hypothesis that defines schizophrenia as a lifelong, restricting mode of relating, involving the primary family triad, that makes the child vulnerable to repeated psychotic episodes. Therapy is directed at the difficulties of autonomous development within the family by focusing on differentiating the relationship between nuclear and extended family members, expecially defining and strengthening generational and sexual boundaries. The second focus of therapy is on the resolution of issues of separation and loss, with attention to unresolved mourning in the family of origin and the concomitant stress in giving up the infantile relationship with the index child in the nuclear family. Stages of therapy will be described including: (a) initiation of therapy, (b) breaking of fusion, (c) repair of alienation, and (d) solidifying the marital alliance and generational boundaries. Case illustrations will be included.     

Adolescent-Parent Attachments Family Problem-Solving Styles

Variation in exploratory and collaborative behavior among family members define different problem-solving styles or “paradigms” in families. Similar characteristics distinguish patterns of attachment within dyads. This suggests an association between these phenomena. The hypothesis was tested in a laboratory study of families with young adolescents. Using the Reiss Card Sort Procedure (CSP) and a newly developed scheme for classifying adolescent attachments, it was demonstrated that particular problem-solving styles were linked to specific patterns of adolescent-parent attachments. An association of paradigms and attachment patterns may afford a new perspective on the dialectical interplay between individual and family development. The probabilities of paradigm-attachment association could prove useful when choosing an intervention model for family therapy.     

Family interventions in schizophrenia: evidence for efficacy and proposed mechanisms of change

Family intervention for psychosis developed from empirical work on the role of emotion in families of those caring for someone with schizophrenia. The level of expressed emotion (EE) has been shown to be a robust predictor of subsequent outcome for service users returning to live in family settings. There is also evidence that staff have similar attitudes. This has led to the development of specific family interventions for schizophrenia. NICE Guidelines for Schizophrenia (2003) confirm that family intervention is effective at reducing service user relapse rates and recommends it for those in contact with carers. Exactly how family intervention improves outcome is less clear. A recent model of psychosis proposes a primarily emotional rather than cognitive route for family factors, and some evidence is presented which supports this. Implications for family interventions are discussed.     

Queer Youth in Family Therapy

Trends in popular belief about same‐sex relationships have undergone noteworthy change in the United States over the last decade. Yet this change has been marked by stark polarizations and has occurred at varying rates depending upon regional, community, racial, religious, and individual family context. For queer youth and their families, this cultural transformation has broadened opportunities and created a new set of risks and vulnerabilities. At the same time, youth's increasingly open and playful gender fluidity and sexual identity is complicated by unique intersections of class, race, religion, and immigration. Effective family therapy with queer youth requires practitioner's and treatment models that are sensitive to those who bear the burden of multiple oppressions and the hidden resilience embedded in their layered identities. We present case examples of our model of family therapy which addresses refuge, supports difficult dialogs, and nurtures queerness by looking for hidden resilience in the unique intersections of queer youths' lives. These intersections provide transformational potential for youth, their families and even for family therapists as we are all nurtured and challenged to think more complexly about intersectionality, sexuality, and gender.     

Family criticism and self-starvation: a study of expressed emotion

The measure Expressed Emotion (EE) has been established as an exceptionally useful indicator of relapse in people with schizophrenia and depression. EE is now also being applied more broadly for the investigation of other disorders. EE is usually rated by conducting the Camberwell Family Interview, i.e. in the course of separate individual interviews with the relatives of the symptomatic individuals. This paper reports the rating of EE in adolescents with eating disorders within a semi-structured family schedule - the Standardized Clinical Family Interview. Consecutive referrals for eating disorders were assessed prior to family therapy and again at regular intervals during therapy. EE ratings for this sample, the prognostic value of EE, and the changes in EE that took place during the course of therapy are presented and their clinical implications discussed. The findings suggest that even low levels of Critical Comments from the parents to the anorexic adolescent are associated with continuing symptoms.     

Family Therapy in Trouble: Psychoeducation as Solution and as Problem

The authors cite clinical literature attesting to the importance of recognizing the family, rather than the individual, as the proper locus of conceptualizing, diagnosing, and treating mental illnesses. Specifically with regard to severe psychiatric illnesses, in particular schizophrenia, family dysfunction contributes to the emergence of the illness, significantly affects its course, and strongly influences the achievement and maintenance of treatment gains. Currently, a movement is afoot to limit sharply the amount and kind of treatment offered to schizophrenic patients and their families. Rooted in a “medical model” or “biogenic” view of the etiology of schizophrenia, this school of thought prescribes psychoeducation as the family treatment of choice. The present article looks at some misconceptions regarding treatment that prompted a widespread turning away from psychoanalytically oriented family psychotherapy for schizophrenic patients and their families, examines the reductionism (biological and behavioral) inhering in the exclusive use of psychoeducation, and looks at the clinical dangers of such reductionism. Finally, it proposes that family psycho-therapists should not abandon a concern with the inner lives of severely ill patients and their families in the face of spuriously generalized claims made by reductionist researchers.     

Family work for schizophrenia: some issues for Chinese immigrant families

This paper discusses some specific issues relevant to immigrant Chinese families in the context of family work for schizophrenia. The issues include shame and guilt, isolation and mistrust of officials, the importance of negotiation before details of problem-solving are worked out, high academic ambitions for children, and apparent ‘overprotectiveness’ in the Chinese culture. It is argued that cognitive-behavioural, goal-orientated family work could be adapted well for immigrant Chinese families with a member suffering from schizophrenia. A case study is presented to illustrate how such a family was helped.     

Family therapy and incomplete families

Much of the literature in family therapy refers to the clinically orientated work with well-motivated families using specific techniques. This article briefly outlines the two main theoretical stances within family therapy as a whole, and describes three categories of incompleteness in families with particular reference to the idea of 'masked' incompleteness. This is illustrated by five case examples which show some of the common difficulties of working with families whose disturbance includes a masked incompleteness. The inadequacies of a singular treatment approach with such families are outlined, and it is suggested that the 'systems' approach in particular has limitations and possible contra-indications in such circumstances. It is argued that the more eclectic and pragmatic approach described, whilst remaining within the boundaries of family therapy as a whole, is likely to offer a more effective consideration of the long term needs of such families.     

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.     

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.     

Factors Associated with Engagement in Family Therapy

Thirty-eight families who continued in conjoint family therapy were compared on a variety of antecedent variables to 13 families who dropped out. Three potentially important predictors of continuance in family therapy were found: (a) which spouse initiated the search for treatment; (b) the level of authoritarianism in the spouses; and (c) family socioeconomic status. Families that dropped out of treatment tended to be of lower socioeconomic status and contained spouses who had more highly authoritarian attitudes as measured by the California F Scale ( 1 ). Families that contained a severly disturbed member had a poor rate of engagement in treatment, but if both spouses in such a family were low in authoritarianism, the engagement rate was 100 per cent. When both spouses initiated the search for treatment, engagement was also nearly perfect. The difficulty in engaging families from the lowest socio-economic class may be attributed partly to the authoritarian attitudes of the husband.     

Family Environment as a Function of Religious Observance in American Jews

An empirical study was conducted to evaluate the hypothesis that perception of family environment among Jews differs as a function of degree of religious observance among Jews. One hundred and one Jewish young adults completed the Moos' Family Environment Scale and a scale measuring degree of religious observance. Compared to the families of more observant young adults, the families of less observant young adults were significantly more organized, more involved in recreational activities, and more concerned with achievement. Clinical implications of research results for family therapy and ideas for future research are discussed.     

Circumplex Model of Marital and Family Sytems

The Circumplex Model focuses on the three central dimensions of marital and family systems: cohesion, flexibility and communication. The major hypothesis of the Circumplex Model is that balanced couple and family systems tend to be more functional compared to unbalanced systems. In over 250 studies using the Family Adaptability and Cohesion Scales (FACES), a linear self-report measure, strong support has been found for this hypothesis. In several studies using the Clinical Rating Scale (CRS), a curvilinear observational measure, the hypothesis was also supported. These two assessment tools, the FACES and the CRS, are designed for research, clinical assessment and treatment planning with couples and families.     

Ecosystemic Structural Family Therapy: Theoretical and Clinical Foundations

Ecosystemic structural family therapy (ESFT) is a systemic, strength-based, and trauma-informed family therapy model that has evolved from structural family therapy (SFT; Minuchin in Families and family therapy, Harvard University Press, Cambridge, 1974). ESFT is an evidenced-based family therapy approach designed to intervene with families of children who are experiencing behavioral health problems and are at the risk of out-of-home placement. In this article we review the theoretical, applied, and empirical evolution of ESFT relative to extant SFT models. ESFT is based on the fundamental assumption that child, parental, and marital functioning are inextricably linked to their relational environment. Five interrelated constructs guide ESFT therapists in their understanding of clinical problems: family structure; family and individual emotional regulation; individual differences (e.g., historical, biological, cultural, developmental); affective proximity; and family development (Gehart 2010). ESFT has an extensive evaluation history dating back to the 1980s involving over 4,000 families in 39 different sites. While ESFT is considered evidence-based, it might be more consistent with “Practice-Based Evidence” given its long, extensive, and successful, history in the child mental health system in Pennsylvania.     

焦虑障碍的系统式家庭治疗

焦虑障碍是最常见的心理障碍之一.其具有症状重、病程慢、复发率高、社会功能明显缺损等特点,给个人、家庭和社会造成了巨大的负担.家庭环境因素在焦虑障碍的发病、转归和预后方面都起到重要作用.本文介绍了国内外关于焦虑障碍患者家庭特点和家庭互动模式的研究结果.系统式家庭治疗作为一种家庭治疗模式,具有其独特的治疗理念和方法,国内外研究结果表明系统式家庭治疗用于焦虑障碍具有良好疗效.今后,还应该运用更加多元化的研究方法探讨中国焦虑症家庭动力学特点和家庭功能,并采用更加严格的随机对照设计,进一步证实系统式家庭治疗对焦虑障碍的治疗效果.     

An Application of Brief Therapy to Family Medicine

The Solution-Focused Brief Therapy model has been applied to support families with various problems commonly met at the department of family medicine in a large, urban teaching hospital in Seoul. Korea. Many cases there show a different distribution of problems when compared with a tertiary family therapy center. The majority involve psychosomatic problems, family distress around a chronically-ill member, the loss of a family member, and severe illness, only a few involving drinking problems, family violence, or abuse. The SFBT model meets the seven requirements of Doherty and Baird (1983) for a family therapy model to be useful in a medicine setting.     

Family process in the treatment of intrafamilial child sexual abuse

The paper describes the changes in family dynamics that occur throughout the process of family-orientated treatment of families where father–daughter incest or stepfatherr–stepdaughter child sexual abuse has occurred. A detailed step-by-step analysis of the developing family process in incest families during therapy is given. The analysis establishes the nature of the original pattern of family relationships, explores the impact made by crisis intervention on the family structure and then outlines therapy and termination of treatment. Characteristic mechanisms in the family process during therapy are described. A detailed clinical example demonstrates the basic therapeutic moves and the mechanisms involved.     

Modes of action of family interventions in depression and schizophrenia: the same or different?

The role of relatives' expressed emotion (EE) in mediating the efficacy of family interventions has been studied in randomized controlled trials (RCTs) involving people with schizophrenia and depression. Reanalysis of two RCTs (n=48) by Leff (1989) indicated that lowering relatives' EE and/or reducing social contact between the patient and family members accounted for the efficacy of the intervention for schizophrenia. However, this relationship has not been investigated previously with regard to depression, and this paper presents the results of a recent RCT which included measurement of EE and other possible mediating variables. In this study, amelioration of the critical attitude of the partner did not account for the superiority of couples therapy over antidepressant medication, since the same change occurred in the drug group. However, reducing the patient's exposure to the partner's hostility partially explained the efficacy of couples therapy. Further research on the process of change in families undergoing therapy is indicated to identify the variables that account for the efficacy of therapy.