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.     

Psychosis and multiple family group therapy

Despite the growing evidence base for the effectiveness of family intervention in the treatment of individuals suffering from a psychotic disorder, in practice only relatively few mental health teams use family approaches when treating and managing those with schizophrenia or other psychoses. This paper describes a pragmatic model, which may be used in addition to other ongoing treatments, such as medication, CBT or single family therapy. It was developed jointly by clinicians and service users over the past few years. It consists of regular multiple family group work, with six to eight families attending simultaneously, and aims to involve families directly in the treatment, rehabilitation and recovery of their members suffering from psychotic disorder.     

A multiple group psychotherapy approach to adolescents with psychiatric and substance abuse comorbidity.

Multiple group psychotherapy was employed as the primary treatment modality in a day-treatment program as an innovative multifaceted approach to treating adolescents comorbid for psychiatric and substance abuse diagnoses. The concurrent educational program included a high school on site. The groups included Substance Abuse Group, which promoted the 12-step model; Health Group; Psychotherapy Group; Leisure Time Group; Self-Awareness Group; and Multiple Family Group. The effect of the multiple groups was to provide a variety of experiences focusing on varied aspects of normal and dysfunctional adolescent development. Together the combination of groups served to strengthen the participants' cohesiveness, communicating skills, and hopefulness.     

A group analytic contribution to family therapy

This paper represents an attempt to add to the conceptual and technical repertoire of family therapy by drawing on experiences derived from group analytic practice. Despite many theoretical points of intersection, there are significant differences in technique dictated by an evolving experience with two fundamentally different types of group. This paper sets out the core concepts of group analysis, compares them with related concepts in family therapy and aims to achieve a synthesis of group analytic family therapy, which, though sharing matters of language and theory with many schools of family therapy, provides in its total conception a unique perspective on family therapy.     

A family systems approach to grief

This article blends two important viewpoints on grief: a stage theory on the individual's grief and the family systems literature on grief. A case study is examined from both the individual and systemic viewpoints. Pastoral implications for intervention with the case study family as a system are noted. The theological questions which the family and pastor face are also discussed.     

A systems approach to ethical problems

Codes of professional ethics and cases designed to teach ethical decision making are written for individual professionals and ignore the systems level of analysis. They typically employ a lineal view of causality and overvalue placement of blame as a component of ethical problem solving. This article takes a systems approach to ethical problems and identifies aspects of systems that promote or impede ethical decision making. Psychological abuse of children is used as an example of a problem requiring a coordinated, systemic response to ethical issues such as autonomy, privacy, and confidentiality.     

The use of children's drawings in multiple family group therapy

This paper describes the advantages, difficulties and techniques of including young children in multiple family group therapy (MFGT). Multiple family group therapy consists of weekly sessions where three or more families meet conjointly with a therapist or cotherapists. Clinical vignettes demonstrate how to use children's drawings with parents to improve family communication. The efficiency of MFGT is compared to family therapy or individual therapy. The effective use of this modality with some children under 10 years is discussed.This research was supported in part by Alcohol, Drug Abuse, and Mental Health Administration Psychiatry Education Branch Grant MH 13882 from the National Institute of Mental Health.     

A hybrid neutrosophic multiple criteria group decision making approach for project selection

The project selection is one of the most important phases of a project life cycle. The project selection is considered as a Multi-Criteria Decision-Making (MCDM) problem. This research aims to study the integration between Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) into Decision-Making Trial and Evaluation Laboratory (DEMATEL) under neutrosophic environment to provide a new technique for making a decision regarding the choice of appropriate project (project selection) as one of the most important phases of the project life cycle. Projects are selected by comparing them against many criteria. Criteria are evaluated based on expert’s opinion. Sometimes experts cannot give reliable information due to the non-deterministic environment. The neutrosophic set theory will be used to handle and overcome the ambiguity or lack of confirmation of information. The criteria are weighted by DEMATEL, then the best project alternative is selected using TOPSIS. In the proposed model, each pairwise comparison judgments is symbolized as a trapezoidal neutrosophic number. Experts will focus only on (n − 1) judgments for n alternatives to overcome the difficulties of [(n * (n − 1))/2] consistence judgments in case of increasing number of alternatives. A numerical example is developed to show the validation of the suggested model in the neutrosophic environment.     

Young Asian children with learning and behaviour problems: A family therapy approach

The paper describes work with five Asian families. The children were failing and showing signs of behavioural disturbance at infant or junior school, and it was felt that this could be due to family psychopathology. Communication with the adults presented some difficulty to the therapist, and there was the additional problem of distinguishing between those patterns of behaviour which were pathological and those which were merely unfamiliar. The approach used was pragmatic and based on the assumption that there is sufficient 'psychic unity' between people of different cultural backgrounds to be used therapeutically, even when communication is difficult.     

A leaderless approach to a minister's peer-support group

This article describes a support group for ministers that uses a leaderless approach. The group has met for over ten years and as a result of that experience has developed in ways that make it unique. These group characteristics are described and are offered as a general guide for ministers as well as members of other helping professions who are interested in peer support.     

A group behavior modification approach to adolescent obesity

This article describes a group weight control project with severely obese adolescent girls in a medical setting. Behavior modification and nutritional principles were utilized with peer group interaction. Significant others were included through separate group meetings. This approach produced small amounts of net weight loss for the girls. The drop-outs continued to have a net gain. As a treatment method, this program was more effective for these girls than previous individual clinic contacts had been. When losing weight, the girls tended to use behavior modification techniques more often, and their diets became more adequate nutritionally. Development of group cohesion was tenuous and temporary. Girls who were functioning more independently appeared to do better in weight loss. Disinterested significant others were preferable to nonsupportive ones. A predictive factor was identified, the girls' perception of control. This was measured by the I-E test. Those with a more internalized perception of control were more likely to continue with the program and more likely to lose weight. Because the patient group was small, findings are tentative. However, this program helped to define particular areas that deserve further exploration.     

Hodgkin's disease in adolescence: A psychoanalytical approach

As a general rule, adolescents suffering from severe organic diseases experience more difficulty than adults and children in recognizing the illness and undergoing treatment, because there is a conflict between accepting the sick body and the sexual body. Dependence on medical treatment, moreover, clashes with the normal drive to autonomy. Long experience as a consultant psychiatrist in the haematology department of a hospital enables the author to propose a hypothesis as to the emotional significance of Hodgkin's disease and chemotherapy, concentrating particular attention on the refusal reaction to the chemotherapy itself. The psychoanalytical psychotherapy of a female adolescent suffering from Hodgkin's disease is presented and discussed to illustrate the theoretical and technical implications.     

Structure of conduct problems in adolescence

Scholars disagree about whether adolescent conduct problems (CPs) form a single behavioral syndrome or whether such problems are better conceptualized as different dimensions. The arguments raised by both sides are addressed and tested empirically by analysing data from a large general population sample of Norwegian adolescents (n = 9,342). Confirmatory factor analyses show that a single syndrome of CPs may be subdivided into three highly correlated factors. The first dimension, destructive covert, includes theft and vandalism, whereas the second, nondestructive covert, reflects avoidance of arenas under adult control. The last dimension, overt, includes school opposition and fighting. This three-factor model fits well for both girls and boys, and individuals in their early and late teens. Results from scale analyses are modestly to moderately indicative of a developmental continuum of severity of CPs ranging from nondestructive covert to overt to destructive covert. Taken together the findings imply that both a unidimensional and a multidimensional perspective on CPs are applicable in the general youth population.     

A time-limited dynamic approach to adolescent inpatient group psychotherapy

In response to sharply curtailed lengths of stay of adolescents in an inpatient psychiatric program, new therapeutic modalities need to be implemented. A time-limited dynamic approach to adolescent inpatient group psychotherapy is presented. The model integrates psychoanalytic and crisis theory into a group format. The primary focus in this model is upon resolution of problematic interpersonal interactions as they are related to the current crisis state. The group process, as related to the adolescent, involves three phases. These include an initial intake phase, which incorporates an ego-functioning assessment; a second or middle phase which focuses on making actions ego-alien; and the termination phase, which incorporates the learning experience and how it relates to the resolution of precipitators of the admission.