An evaluation of a partial training program in psychiatric residency on the later practice of marital and family therapy

Abstract

This paper reports on the results of a survey of psychiatrists and residents who received marital and family therapy training during their second year of residency. The data indicate that such training has an immediate positive effect on practice and is carried forward into later practice. Practicing psychiatrists trained in marital and family therapy during residency report spending 25% of their caseloads in marital and family therapy which was seen as producing positive change in patients. In line with previous training, practicing psychiatrists define the unit of treatment as more than an identified patient and treat marital and family therapy cases themselves or refer to others for such therapy. Variations in practice and techniques raise questions regarding the structure and content of marital and family therapy training in psychiatry residency programs and point out the importance of such training in the later practice of psychiatry.     

Parentification and the Impostor Phenomenon: An Empirical Investigation

The therapeutic alliance has consistently predicted client outcomes in psychotherapy. This study uses attachment theory as a resource in understanding the therapeutic alliance. Participants in this study were 27 mothers, 15 fathers, and 23 adolescents that participated in family therapy. Results indicate that mothers' reports of trust in their oldest child predicted the alliance, and adolescent ratings of trust in mothers and fathers moderated the relationship between therapy alliance and symptom distress. Implications for family therapy research and practice are discussed.     

The impact of structural family therapy training on conceptual and executive therapy skills

The importance of empirical evaluations of family therapy training is gaining increased recognition. This study reports the results of a controlled assessment of a training seminar in structural family therapy. Changes in the conceptual and executive skills of 44 therapy trainees (22 family trainees and 22 controls) were assessed over a 16-week period using repertory grid and videotaped therapy simulation techniques. Results indicated significant conceptual gains in family therapy trainees, but only among those with little previous exposure to family training. Differences in the overall number as well as the type of interventions were also noted. Results generally supported the predicted impact of therapy training, but left unanswered questions regarding the unique impact of family therapy training over individual training. These qualifications are discussed and directions for future work are highlighted.     

Depressed youth: treatment outcome and changes in family functioning in individual and family therapy

This study explores the role of family functioning in therapeutic change in focused individual psychodynamic psychotherapy (FIPP) and time‐limited systems integrative family therapy (SIFT) for depressed children and adolescents. After a screening process, 72 participants aged 8 to 15 were randomized to either FIPP or time‐limited SIFT. Assessments took place prior to, at the end of, and 6 months after treatment. Families in both SIFT and FIPP showed a small but significant and sustained improvement in family functioning by the end of treatment in both mothers' self‐reports and family therapists' assessments. Better family functioning at baseline in mothers' self‐reports and improved family functioning during SIFT, as assessed by family therapists, predicted a sustained decrease in self‐reported depressive symptoms. Results indicated that time‐limited SIFT may be more effective with younger children and in patients without a diagnosis of double depression than adolescents.     

Children's and Adolescent's Views on Family Therapy

Family therapy has made a considerable contribution to our understanding of the experiences of children and families and especially how various symptoms can be understood as their response to distressing family dynamics. Though family therapy has found ways of alleviating children's distress we still know relatively little about how children experience the process of family therapy. Such knowledge is important for ethical as well as pragmatic reasons – to be able to offer a more sensitive and effective experience. This paper reports a study employing qualitative methods whereby children were interviewed about their experience of family therapy. Semi-structured interviews were conducted after family therapy sessions, and children were invited to recall what they perceived to be helpful and unhelpful. Helpful events or moments were then identified and replayed on the videotape of the sessions to assist children's memory. The results suggest a diversity of experiences according to the children's ages, gender and role in the family. Some common assumptions were challenged by the findings, for example, that some children preferred more directive and focused aspects of the therapy, rather than systemic questions which could inspire feelings of confusion and inadequacy.     

Brief family therapy for childhood tic syndrome.

This paper reports the success of brief analytically oriented outpatient family therapy exclusively in treating an eight-year old girl presenting with a short history of multiple tics involving facial, thoracic, and upper limb musculature, with associated hoarse coughing and grunting. Diagnostic features are reviewed. No medicines were used, and the patient remained asymptomatic nine months after ceasing family therapy. Tentative indications for family therapy for tiqueurs are proposed.     

An exploratory study into how a sample of a British South Asian population perceive the therapeutic alliances in family therapy

There is currently little research on the therapeutic alliances in family therapy, and even less on those from minority ethnic backgrounds. This paper reports on how British South Asians attending family therapy perceive the alliances, and compares this to the constructs of a newly developed tool – the System for Observing Family Therapy Alliances. Nine participants were interviewed and thematic analysis was employed to analyse the data. The results suggest that certain aspects of the alliances may need more attention when working with this ethnic group. These are safety in front of the therapist and emotional connection to the therapist (including feelings towards the reflecting team and consideration of ethnically matching therapist and client). In general, the quality of the alliance is seen as more important than employing culturally specific techniques. The implications for diversity and family therapy training are discussed.     

Review and reflections on 40 years of family therapy development in Taiwan

Although the systemic approach is considered to fit Chinese culture, the development of family therapy in Taiwan is recent, starting in 1969, and growing as a treatment modality in Taiwan for the past two decades. To examine this development, this article reviewed 127 locally published family therapy studies published during the years 1969–2009. Content analysis was used to examine these articles and the results clearly showed an increase in the amount of publications during this period. The focus of the studies also shifted from theoretical issues to practical concerns. An analysis of 15 of these articles, which were case reports, suggested a preference for local common practice, for example, a focus on therapist manoeuvres rather than the clients' perspectives, which might have hindered the development of successful practice. The availability of only certain forms of training might also have contributed to the clinical focus of family therapy in Taiwan. The article suggests that greater interest in the therapy process in future will enhance local practitioners' clinical efficacy.     

Schizophrenia and the Family: II. Adverse Effects of Family Therapy

Theoretical formulations of the past thirty years have championed the hypothesis that family interaction contributes heavily to the etiology of schizophrenia, a position that has dominated contemporary family therapy even in the absence of solid empirical confirmation. The possibility that sociogenic modeling of schizophrenia is not only incorrect but even harmful to families, and to the relationship between families and clinicians, has never been taken seriously, despite its implications for the practice of family therapy. The author describes untoward effects of the sociogenic hypothesis in his own ten-year experience with families of chronic schizophrenics and examines pertinent reports in the family therapy literature, offering the reinterpretation that many communicational aberrations are adaptations to two therapist attributes: (a) failure to absolve the family of initial causal responsibility, and (b) failure to inform the family about the nature of the illness.     

Treatment Expectations and Treatment Experience of Chinese Families Towards Family Therapy: appraisal of a common belief

This paper reports results of a qualitative study on family therapy conducted in Hong Kong, which aims to identify Chinese families' treatment expectations, delineate their subjective experience and the outcome in treatment. By comparing the expectations, the experience and the outcome, this study examines and challenges the belief that the practice of family therapy should necessarily be fundamentally adapted to be 'culture-specific', an assumption that has hitherto been untested and possibly based on overgeneralized cultural stereotyping. This study provides empirical evidence for family therapists who have interests in working with local and overseas Chinese families to improve their practice.     

Training Facilities in Marital and Family Therapy

This survey reports the results of a national survey of training programs in family therapy. Two hundred and forty-five programs responded to the survey questionnaire providing data for the development of a master list of training programs and a general assessment of the nature and magnitude of training efforts in the field. The survey included programs housed in diverse institutional settings. The data indicate the extent of growth and the increasing formalization of professional training in family therapy. A classification system is proposed for distinguishing among the major types of facilities providing family therapy training. Programs are compared in terms of the type, duration, and intensity of the training offered and the number of students enrolled.     

Trainee perspectives on their family therapy training

Although research into family therapy training is increasing it has so far mostly focused on the process of the teaching and acquisition of certain concepts and skills. In contrast, the experience of training as family therapists has rarely been investigated. This paper reports on the impact of family therapy training at one training institution in the UK on the personal, relational and professional identities of trainees. Six family therapy trainees were interviewed using semi‐structured interviews at regular intervals over a period of approximately twenty months. Interpretive phenomenological analysis (IPA) was employed to analyse the interviews. The results suggest that participants often found the experience of training as a family therapist overwhelming and de‐skilling, but that it nevertheless provoked a re‐evaluation of some of their established personal, relational and professional identities. In many cases these re‐evaluations seemed to have preceded a process of individuation, of assuming a different or more complex identity.     

Divorced Parents in Family Therapy in a Residential Treatment Setting

Divorced parents are required to participate together in the family therapy of their child placed in a residential treatment center. Different sources of resistance and treatment techniques are identified and discussed through a theoretical analysis and case study material. The therapy of these fractured families contributed to an elimination of recidivism and, according to followup reports, to significant and sustained improvement in the children's functioning in school, home, and community activities.     

A Cognitive-Behavioral Approach to Family Therapy

Although cognitive behavioral spectrum approaches with individual children are plentiful and demonstrate effectiveness, cognitive behaviorally oriented clinicians are frequently left to their own devices when it comes to treating families. Cognitive behavioral family therapy is a relatively recent development and there are precious few reports of its clinical use. This article presents a conceptual foundation and clinical rubrics for the practice of cognitive behavioral family therapy. Basic theoretical background information is presented and places the therapeutic processes and procedures in a proper context. Session structure in cognitive behavioral therapy is illustrated and the way it propels therapeutic momentum and adds focus to each session is explained. Rudimentary processes of self-monitoring, self-instruction, rational analysis, and behavioral enactment are described and augmented with case material. Finally, the conclusion offers directions for further theory building, research, and clinical practice.     

The Present Moment in the Primary Triangle

ABSTRACT

Daniel Stern described the present moment as “what happens here, now, between us” (BCPSG, 2010, p. 41). Stern considered the present moment as the basic unit of intersubjective communication or the sharing of inner states for both mother-infant pairs and therapist-patient dyads. He emphasized the importance of implicit processes for fostering change in relationships. Evidence collected during the last three decades in the Lausanne Centre for Family Studies points to a parallel, but collective form of intersubjective communication in the family that originates in infancy, thanks to the previously unknown competence of the young infant for multipartite interaction and sharing inner states with others. Collective intersubjectivity opens up new avenues for the understanding of development and change in the family, as well as for family therapy. These results are illustrated in several case vignettes and discussed in reports of conversations with Daniel Stern.     

A neglected triangle: Grandmother,mother, and daughter

This paper reports on exploratory research and therapeutic work with a neglected but highly important family triangle, the grandmother-mother-daughter triangle. Some characteristic relationships are described from a clinical sample of 18 daughters for whom such a triangle was important. The triangle may signal both problems and strengths for therapy and the daughters.     

Costs of Treating Conduct Disordered Medicaid Youth with and without Family Therapy

This longitudinal, retrospective study investigated the healthcare costs of youth treated for conduct disorder in the Kansas Medicaid system. Along with a comprehensive range of services, youth received in-office individual therapy, in-office family therapy, or in-home family therapy. Data was available for 3753 youth. Overall, 3086 youth received care that included individual therapy (and no family therapy), 503 received in-home family therapy and 164 others received in-office family therapy. Healthcare costs for a period of two and one half years after therapy were available for analysis. The average cost of healthcare for youth receiving no family therapy was $16, 260. For those receiving in-office family therapy, the average cost was $11,116. Youth who received in-office family therapy received $5,144 (32%) less care on average than those receiving only individual therapy. Those who received in-home family therapy averaged $1,622 over the follow-up the period. Those who received in-home family therapy were least expensive of all, averaging at least 85% less than any form of in-office therapy. There does not appear to be an increase in the healthcare cost when family therapy is included in treatment.     

Relationships between early and final reports of treatment outcome in long-term group psychotherapy

A study of the report of treatment outcome in three long-term therapy groups focused on two questions: 1) Are early reports of treatment outcome significantly related to final reports, i.e., is there substantial consistency in outcome reports over the course of therapy? 2) Are final reports of treatment outcome significantly more favorable than early reports, i.e., do patients experience significant improvement after the early part of therapy? Affirmative answers to these two questions for a number of outcome variables led to a consideration of a number of clinical and research implications.