Family therapy and systemic interventions for child‐focused problems: the current evidence base

This review updates previous similar papers published in JFT in 2000, 2009 and 2014. It presents evidence from meta‐analyses, systematic literature reviews, narrative literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with common mental health problems and other difficulties. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training, or parent implemented behavioural programmes. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for sleep, feeding and attachment problems in infancy; recovery from child abuse and neglect; conduct problems, emotional problems, eating disorders, somatic problems, and first episode psychosis.     

Family therapy and the glamour of science

It is argued that family therapy has adopted esoteric and unrelated theories from 'New Science' in order to maintain its glamour and individuality in comparison with other therapies. One unfortunate consequence of this is to limit the development of the practice of family therapy by prejudicing empirical validation. An alternative approach which attempts to integrate linear and systemic viewpoints is suggested.     

Family therapy and communion

There has been a shift of healing authority in our culture from priestly practitioners to scientific and medical practitioners. As part of this change the care and healing of stressed or broken families is now seen as the responsibility of the family therapist. A consequence of this has been some role confusion on the part of the clergy and therapists. A comparison of the symbolic complex of belief and value systems used in MacGregor's team-family method of family therapy and Joseph Haroutunian's theology of the church shows four striking similarities. The implications of these similarities for the continued confusion or clarity of the roles of priest and therapist are noted.Rev. Fitchett is Chaplain-Supervisor and Assistant Professor, Department of Religion and Health, Rush-Presbyterian-St. Luke's Medical Center, 1753 West Congress Parkway, Chicago, Illinois 60612.     

Family therapy and soiling

Children and families referrred for soiling problems present special challenges to family therapists. Behaviour modification and the externalizing approach of White and Epston are considered in relation to these challenges. Externalizing may offer advantages over existing approaches and deserves systematic evaluation.     

Family therapy in the home

There is good evidence in other areas of therapeutic endeavour that home-based therapy may have advantages over clinic-based work for some patients. There are some families who have real difficulties in attending clinics. Despite these facts little has been written on the topic. This brief article reviews some of the objections to home-based family work and suggests possible solutions for the interested therapist.     

Family systems therapy

Journal of Child and Family Studies -     

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.     

Family therapy and clinical psychology

The results of a survey of 111 clinical psychologists in the Republic of Ireland along with some comparable data from US and UK surveys were used to address a series of questions about the link between family therapy and clinical psychology. Family therapy was not a clearly identifiable sub-specialty within clinical psychology in Ireland. Family therapy theoretical models were used by more than a quarter of the Irish sample to conceptualize their work but by less than a tenth of US and UK respondents. In all three countries about a tenth of treatment time was devoted to the practice of family therapy. In Ireland, the use of family systems models, family assessment interviews and family therapy was more common within the child and family specialty than within the mental handicap or adult mental health clinical psychology specialties. The experience of live supervision and participation in family or couples therapy were important formative factors in the development of some clinical psychologists. Further training in systemic consultation, particularly in situations where an abuse of power has occurred, was identified in the survey as a priority area for continuing professional development. The evolving relationship between family therapy and clinical psychology is discussed in the light of these findings.     

Family therapy and psychosomatic illness

The author suggests that clinical experience has developed to the point where the question can be asked, “Is a specific psychosomatic illness responsive to a specific type of family therapy?” Examples such as structural family therapy in childhood diabetes, asthma, pain, and anorexia nervosa; cognitive family therapy in adult chronic pain; and marital group behaviour modification in adult obesity, chronic pain, and myocardial infarction, are critically reviewed. The evidence suggests, but does not yet prove, that specific types of marital and family therapy may be effective in a few specific psychosomatic problems, a useful adjunctive therapy in some psychosomatic problems, and that family assessment is helpful in the management of all psychosomatic problems.     

Family therapy for the borderline patient

Family therapy can be an appropriate modality of treatment for borderline patients: family sessions may be helpful in making order out of chaos in the system. It also takes into account the fear of separation and other developmental issues which are of concern to the borderline patient. Issues related to the structure and format of sessions in the beginning and middle phase of therapy are discussed. Progress and treatment implications including transference reactions are examined. We have concluded that the family members in a case presented have become considerably stronger and more independent. Their current developmental level indicates that we can begin to work on intrapsychic factors.     

Family therapy: the rest of the picture

The specialist literature on family therapy naturally tends to focus only on the special features of what is a much larger body of skills and knowledge. To redress the balance this paper outlines the rest of the picture in various ways. About 90 separable component parts of family therapy are described. Some implications of this analysis are identified.     

Family therapy with incest

Intervention to interrupt the cycle of incest poses unique considerations for the clinician. This paper presents a multilevel intervention model making use of the family system and subystems within it to interrupt the incest cycle. The discussion provides a perspective for the clinician for intervention with such families including the use of dyads: Husband-wife, father-daughter, mother-daughter. It focuses on the central importance of strengthening the marital dyad while providing support for realignment of dysfunctional coalitions which allowed for the emergence of the incest cycle. Boundaries, collusion, the use of the therapy team, and implications for treatment are integral to the discussion.