神经性厌食症的家庭治疗--西方关于神经性厌食症心理治疗的新进展

弗洛伊德关于家庭和心理性别发展的论述给神经性厌食症的理解、分析与治疗带来了新的关注焦点,在其之后的学者将他的思想进一步继承和发展,创造出了以家庭为关注对象的且在当代得到广泛应用的系统家庭疗法,并将该疗法应用到了神经性厌食症的诊断与治疗中,取得了开创性的成果.     

Anorexia Nervosa in Adolescence and Maudsley Family‐Based Treatment

Anorexia nervosa is a serious psychiatric disorder that usually occurs in adolescence. The course of the illness can be protracted. Current empirical evidence suggests that the Maudsley Family‐Based Treatment (MFBT) is efficacious for adolescents. MFBT empowers parents as a crucial treatment resource to assist in their child's recovery. The authors review the diagnostic criteria and course of anorexia in adolescence, present empirical evidence and key theoretical concepts of MFBT, and provide a case study.     

工作与家庭冲突：压力的交叉传递效应

工作与家庭冲突是指个体的工作和家庭角色压力不相容时产生的冲突,包括工作影响家庭、家庭影响工作两个方面。工作与家庭冲突对个体、家庭和组织都会造成消极影响。本文从交叉传递效应的视角,系统地回顾与总结工作与家庭冲突方面的研究,以动态的角度阐述压力在配偶之间的交叉传递,并介绍了最新的“溢出-交叉传递效应”模型的研究。最后,有针对性地提出了未来研究的展望,包括国内研究应重视的研究问题。     

Femininity, Mental Weakness, and Difference: Male Students Account for Anorexia Nervosa in Men

The purpose of this study was to examine how men account for the diagnosis in men of anorexia nervosa (AN), a condition commonly associated with women. Male students participated in focus group discussions of topics related to AN. Discussions were tape-recorded with participants' consent, transcribed, and then analyzed using discourse analysis. The participants spontaneously constructed AN as a female-specific condition. When asked to account for AN in men, they distanced AN from hegemonic masculinities in ways that sustained both dominant masculine identities and gender-specific constructions of AN. These findings show how issues of health and gender are interlinked in everyday understandings of AN. Future researchers might usefully consider how the construction of gender-specific illness implicates wider notions of both feminine and masculine gender identities.     

A Pilot Open Trial of a Digital Mindfulness-Based Intervention for Anorexia Nervosa

Anorexia nervosa (AN) is a chronic and debilitating psychiatric disorder. Unfortunately, current treatments are lacking, with only 30-50% of individuals with AN recovering after treatment. We developed a beta-version of a digital mindfulness-based intervention for AN called Mindful Courage-Beta, which includes: (a) one foundational multimedia module; (b) 10 daily meditation mini-modules; (c) emphasis on a core skill set called the BOAT (Breathe, Observe, Accept, Take a Moment); and (d) brief phone coaching for both technical and motivational support. In this open trial, we aimed to evaluate (1) acceptability and feasibility; (2) intervention skill use and its association with state mindfulness in daily life; and (3) pre-to-post changes in target mechanisms and outcomes. Eighteen individuals with past-year AN or past-year atypical AN completed Mindful Courage-Beta over 2 weeks. Participants completed measures of acceptability, trait mindfulness, emotion regulation, eating disorder symptoms, and body dissatisfaction. Participants also completed ecological momentary assessment of skill use and state mindfulness. Acceptability ratings were good (ease-of-use: 8.2/10, helpfulness: 7.6/10). Adherence was excellent (100% completion for foundational module and 96% for mini-modules). Use of the BOAT in daily life was high (1.8 times/day) and was significantly associated with higher state mindfulness at the within-person level. We also found significant, large improvements in the target mechanisms of trait mindfulness (d = .96) and emotion regulation (d = .76), as well as significant, small-medium to medium-large reductions in eating disorder symptoms (ds = .36–.67) and body dissatisfaction (d = .60). Changes in trait mindfulness and emotion regulation had medium-large size correlations with changes in global ED symptoms and body dissatisfaction (rs = .43 – .56). Mindful Courage-Beta appears to be promising and further research on a longer, refined version is warranted.     

Meta‐Analysis of Anorexia Nervosa Counseling Outcome Studies From 1990 to 2015

This meta‐analysis of 92 anorexia nervosa counseling articles examined the effectiveness of counseling in reducing symptoms of anorexia nervosa at termination and the longest follow‐up assessments. Treatment‐as‐usual studies showed no effect to small effects at both posttest and follow‐up assessments, wait‐list studies showed small effects at posttest and medium effects at follow‐up, and single‐group uncontrolled studies showed medium to large effects at posttest and medium effects at follow‐up. Implications for research and practice are discussed.     

The Psychological Battle for Control: A Qualitative Study of Health-care Professionals' Understandings of the Treatment of Anorexia Nervosa

This paper reports a qualitative, idiographic study, which intensively examines a multidisciplinary team of clinicians' subjective understandings and experiences of treating young people with anorexia nervosa. The study employs semi-structured interviews and interpretative phenomenological analysis, these methods enabling individual clinicians' perspectives to be explored in depth and retained within the analysis. The analysis focuses on the salient higher-order theme of control which emerges as central to understanding the treatment of the anorexic child. Three control-related themes are used to illustrate the multiplicity of meanings and experiences which are relevant to this team of health-care professionals. It is suggested that this paper makes three important contributions to the current eating disorder literature: illuminating the multi-faceted nature of the construct control; highlighting the importance of therapists' subjective understandings and experiences; and illustrating the value of qualitative methods for clinically relevant research. © 1997 John Wiley & Sons, Ltd.     

Family Support and Conflict: Prospective Relations to Adolescent Depression

The relations between family support, family conflict, and adolescent depressive symptomatology were examined longitudinally in a sample of 231 female and 189 male adolescents and their mothers. Structural equation models revealed that less supportive and more con-flictual family environments were associated with greater depressive symptomatology both concurrently and prospectively over a 1-year period. Conversely, adolescent depressive symptomatology did not predict deterioration in family relationships. Depressive symptomatology and, to a greater extent, family characteristics showed high levels of stability over the 1-year period. Counter to our expectations, the relations between family variables and depressive symptomatology were similar for boys and girls. The results suggest that the quality of family interactions is relevant for understanding the development of depressive symptoms in adolescents.     

Work and Family Conflict: An Often Overlooked Issue in Couple and Family Therapy

Despite the systemic interaction, family-based journals, as well as intake and assessment forms most frequently used by couple and family therapists (CFTs), have given a limited amount of attention to the issue of work and family conflict. Moreover, a review of the literature indicated that many CFTs perceive themselves as inadequately prepared to assist couples and families with work and family conflict. Addressing this apparent limitation, the present study identified various work stressors that contributed to family conflict (WFC), and the family stressors that contributed to work conflict (FWC). Results revealed significant predictors of WFC and FWC. Implications for CFTs and recommendations for changes in academic training and supervision are provided. The authors would like to thank Dr. Gary Bischof, Associate Professor of Counselor Education and Marriage and Family Therapy program Director at Western Michigan University, for editorial comments made on a previous version of this paper.     

Anorexia Nervosa: The Hospital's Role in Family Treatment

When an anorexia nervosa patient requires hospitalization for her ¹ 1 We will use the pronoun “her” to refer to anorexic patients since the overwhelming majority are female. Our discussion will focus mainly on younger adolescent girls who are still living with their families.
medical condition, the treatment team faces the problem of integrating the individual focus of inpatient care with the systems focus of family therapy. In this paper we propose a family-systems model of hospitalization, the aim of which is to facilitate such integration. The model draws on current theories of anorexia nervosa, as well as general concepts from psychodynamic, developmental, and family systems theories. The major hypothesis of the model is that all members of the anorexic family are developmentally arrested in the area of separation-individuation. On this assumption, we propose that the entire treatment team (including medical professionals and therapists) needs to function as “parents” to the anorexic family in much the same way that two cotherapists become parental figures in family therapy. Specifically, the team needs to provide those parenting responses that facilitate the family's individuation process.     

Experiential Family Therapy: An Innovative Approach to the Resolution of Family Conflict in Genetic Counseling

Experiential family therapy is an intuitive approach that utilizes active, multisensory techniques. These techniques, such as role plays and drawings, increase the family's expression of affect and uncover new information. Increased affect and uncovered information stimulate change and growth in the family system. Experiential techniques are especially useful when more traditional, verbal-based communication is not effective. In this article, I will present a pediatric case in which the patient, a 7-year-old boy diagnosed with autism, was referred to the genetics clinic to rule out the presence of an associated genetic disorder. I will then describe a hypothetical second counseling session with the same family and suggest how three experiential family therapy techniques: family drawing, empty chair technique, and continuums might be used in the session to help resolve a marital conflict between the patient's parents.     

Family Business-Owning Couples: An EFT View into Their Unique Conflict Culture

This study expands the understanding of business-related tensions within business-owning couples through an interdisciplinary literature review, through a longitudinal data analysis, and through application of Emotionally Focused Therapy (EFT) to a case study. Business-owning husbands and wives in this study reported that conflicts related to work/family life balance and unfair distribution of resources (money, time, energy) between family and business systems create the greatest tensions. Low family functionality, wives' role dissatisfaction, transfer of resources from family to business, and husbands' identification of wives as major decision makers were all predictors of wives' higher tension levels. Husbands reported increased tension when wives worked more hours in the business. Three elements of EFT are applied to a family business couple.     

Employees' Sense of Community, Sense of Control, and Work/Family Conflict in Native American Organizations

This study examines two critical psychological states—employees' sense of work community and their sense of control—as mediating variables between personal/work factors and work/family conflict in the context of two Native American organizations. The questionnaire data come from 151 employees, 77 of whom are Nez Perce Indians. Results using structural equation modeling show that employees' sense of community and sense of control at work mediate the relationship among four personal/work factors (employees' ethnicity, family-sensitive supervision, the intrinsic value they place on their work, and work flexibility) and work/family role conflict.     

A measure for the assessment of eating disorders: reliability and validity studies of the Rating of Anorexia and Bulimia interview - revised version (RAB-R)

The Rating of Anorexia and Bulimia interview (RAB) is a Swedish semi-structured interview for clinical and research purposes for a wide range of eating disorder symptoms and related psychopathology. The objectives were to evaluate the reliability and validity of a revised RAB version (RAB-R). The RAB-R was assessed in terms of internal consistency, inter-rater and test-retest reliability, and criterion and convergent validity. Samples included a clinical sample of eating disorder patients (n = 71) and a sample of randomly drawn female controls (n = 31). The RAB-R showed satisfactory internal consistency, inter-rater and test-retest reliability, correlated well with related measures, and discriminated between patients and normal controls. We conclude that the RAB-R is a promising interview instrument and continued evaluation should focus on comparing subgroups of eating disorder patients with other clinical groups.     

Family Members' Retrospective Perceptions of Intrafamilial Relationships

Parents and daughters in 21 families of women with borderline personality disorder (BPD), 23 women with restricting anorexia nervosa (AN), and 25 women without clinical histories (NC) responded to the Parental Bonding Instrument (PBI) and the Beavers Self-Report Family Inventory (SFI). On the PBI, BPD daughters' perceptions differed from both their parents' whereas AN daughters' perceptions differed from their mothers'. On the SFI, both groups reported less family health than their parents. On both instruments, nonclinical daughters' perceptions were congruent with the parents'. These findings have implications for researchers and therapists for integrating and utilizing the varying perceptions of family members.     

Family Conflict and Children's Internalizing and Externalizing Behavior: Protective Factors

The current investigation examined whether the positive association of family conflict to adolescent depression and conduct problems is attenuated by maternal, paternal, and peer attachment, and maternal and paternal monitoring, within a low-income, multiethnic sample of 284 adolescents. Parental attachment and monitoring moderated the link from family conflict to conduct problems but not depression; the relationships among family conflict, the hypothesized protective factors, and conduct problems were further modified by adolescent gender but not ethnicity. In general, higher levels of the hypothesized protective factors attenuated the relationship between family conflict and conduct problems for girls but exacerbated this relationship for boys. These findings suggest that, in general, parental attachment and monitoring served as protective factors for girls while serving as additional risk factors for boys in conflictual families.     

An Exploratory Evaluation of the Family Meal Intervention for Adolescent Anorexia Nervosa

Although weight restoration is a crucial factor in the recovery of anorexia nervosa (AN), there is scarce evidence regarding which components of treatment promote it. In this paper, the author reports on an effort to utilize research methods in her own practice, with the goal of evaluating if the family meal intervention (FMI) had a positive effect on increasing weight gain or on improving other general outcome measures. Twenty‐three AN adolescents aged 12–20 years were randomly assigned to two forms of outpatient family therapy (with [FTFM] and without [FT]) using the FMI, and treated for a 6‐month duration. Their outcome was compared at the end of treatment (EOT) and at a 6‐month posttreatment follow‐up (FU). The main outcome measure was weight recovery; secondary outcome measures were the Morgan Russell Global Assessment Schedule (MRHAS), amenorrhea, general psychological symptoms, and eating disorder symptoms. The majority of the patients in both groups improved significantly at EOT, and these changes were sustained through FU. Given its primarily clinical nature, findings of this investigation project preclude any conclusion. Although the FMI did not appear to convey specific benefits in causing weight gain, clinical observation suggests the value of a flexible stance in implementation of the FMI for the severely undernourished patient with greater psychopathology.