The impact of psychiatric diagnosis and family system relationship on problems identified by families coping with a mentally ill member.

The purpose of this study was to explore how psychiatric diagnosis and family relationships relate to problems identified by participants in three one-day public family psychoeducation workshops for families with a member with a serious mental illness. Workshop participants generated lists of problems they had faced, which were coded into eleven categories. Logistic regression models predicting listing of categories were developed based on ill member (diagnosis, sex, treatment compliance) and family member (sex, age, relationship to the ill member) characteristics. For models predicting content category from ill member characteristics, only denial/noncompliance and interpersonal/social categories were significantly predictive as dependent variables. For models predicting content categories from family member characteristics, only the resources/benefits model was predictive. The significant findings, in conjunction with the important negative results, suggest implications for further development of family intervention models. Building on previous research, groups composed of families coping with more than a single diagnosis and including a variety of family member relationships have the potential to reach consensus on curriculum topics.     

Medical family therapy: an emerging arena for family therapy

This paper describes an important recent development in American family therapy. Medical family therapy uses a biopsychosocial systems model to work with families who have a member with a chronic illness or disability. The authors maintain that family therapy has tended to embrace the mind–body split and to view itself too narrowly as a mental health specialty. Medical family therapists work collaboratively with physicians and other health professionals to help families achieve a sense of agency and communion in facing some of the greatest challenges that life brings.     

Behavior modification in marriage counseling

Abstract

Telephone cotherapy via three-way conference call of symbolic-experien-Hal family therapy is presented in a way that captures the spirit of a great pioneer, Carl Whitaker, M.D. The problems of the family, the process of therapy, and the beginning and ending are presented in a manner intended to bring the reader inside the experience. There are particular focuses on the use of family political power by both family therapists and an anguished family member in mobilizing the family for therapy. Impact is demonstrated in helping a family who felt hopeless become hopeful. The family attained a family spirit.     

A taste of reflecting practice

This article describes a training exercise in which students who are new to systemic practice but have some experience in therapeutic work in other modalities were invited to experience reflecting practice. The students were asked to follow a role‐played therapy session by offering reflections on the connections felt to a ‘family’ member. The students stood beside the ‘family member’, reflected on the problems and accounted for the connections felt in terms of particular resonances felt. The students thus experienced a therapeutic use of self congruent with the reflecting team approach and the therapeutic position adopted in reflecting practice.     

The patient in the family and the family in the patient

The notion that the family is “the unit of care” for family doctors has been enigmatic and controversial. Yet systems theory and the biopsychosocial model that results when it is imported into medicine make the family system an indispensable and important component of family medicine. The challenge, therefore, is to provide a coherent, plausible account of the role of the family in family practice. Through an extended case presentation and commentary, we elaborate two views of the family in family medicine — treating the patient in the family and treating the family in the patient — and defend both as appropriate foci for care by family doctors. The practical problem that arises when the family is introduced into health care is deciding when to concentrate on the family system. The moral problems that arise concern how extensively doctors may become involved in the personal lives of their patients and families. The patient-centered clinical method provides a strategy for handling both problems. Thus, making the family a focus of care in family medicine can be justified on theoretical, practical, and moral grounds.     

Family Therapy and Alternative Medicine: Acupuncture as a Case in Point

Collaboration between family therapists and alternative medicine practitioners is recently cultivated ground that may prove to be fertile territory for the application of family therapy skills. Acupuncture and family therapy are two healing practices that differ in cultural tradition, language, and technique, yet they appear to share some underlying assumptions suggestive of a natural alliance in helping people with a variety of biopsychosociospiritual problems. This paper describes the process of interdisciplinary collaboration between an acupuncturist and family therapist via a clinical vignette, identifying different types of referral situations, and suggesting factors of effective collaboration that can synergistically enhance a patient and family's treatment.     

Well-being and Need for Support of Adolescents with a Chronically Ill Family Member

This study investigates whether there are differences in the well-being, need for help and use of support services between adolescents with and without a chronically ill or disabled family member. It also examines the role played by the type of illness, the relationship to the family member and the nature and intensity of the help provided by the adolescent. A Dutch sample of 1581 adolescents (average age 14.6?years) completed a questionnaire in 2010 about mental health problems, pro-social behavior, need for and use of support and the illness of family members and any care tasks performed by the respondent. Young people with a sick family member had more mental health problems than their counterparts without a chronically ill family member. They also reported a greater need for and use of help and support. Performing domestic tasks was found to be a predictor for overall mental health problems. The intensity of the help given was related to the need for help by the adolescent. It is concluded that growing up with a chronically ill family member and spending a lot time performing (domestic) tasks are risk factors for adolescent mental health problems and adolescents’ need for help. Special attention is warranted for those who need support but who do not translate that need into reality by seeking help.     

Family therapy and social control with incestuous families

The family therapy and social control model describes first the relationship between unplanned change and developmental growth. With many families, the family therapist works to both provoke change and encourage growth. However, some out-of-control families present a level of danger to a family member that outside controls, such as child protective services, must be used. This model clarifies the complementary but independent roles of family therapy and social control in helping out-of-control families. Intervention with incestuous families is presented as illustrative of the model.My thanks to the staff of Child Protective Services, the Juvenile Court, Yuma Police Department, Yuma County Sheriff's Department, Adult Probation Department, and the staff and group members of Yuma County, Arizona Parents United for showing that shared concern about the well-being of children can make a real difference in working with families. My appreciation to William C. Nichols, EdD, Elora Cornille and Dale Brotherton for their helpful suggestions on a earlier version.     

ABSTRACTS OF LITERATURE

This is a clinical controlled study comparing the effects of "behaviorally" orientated family therapy, "client-centered" family therapy, and no therapy at all for families with a delinquent member. Sample included 99 families randomly assigned to treatments. Results indicated the efficacy of the behavioral family therapy in reducing recidivism.     

Unilateral family therapy for alcohol abuse: A working conception

Abstract

Unilateral family therapy is presented as a new mode of family therapy in which intervention is directed toward changing the behavior of an uncooperative family member through working with a cooperative member as mediator. In this initial exposition of the unilateral approach, it is applied to the problem of endeavoring to reach and change an uncooperative alcohol abuser through giving therapeutic assistance to a cooperating spouse. A working conception of this mode of therapy is presented based upon the authors' current clinical research in this area. Directions for further research and development are identified.     

Enlisting family support in drug treatment

Drug abuse programs often experience difficulties involving clients' families in treatment. This article describes general principles and specific techniques for recruiting family members in drug abuse programs and in other treatment settings. Stanton and Todd's principles of recruiting for family therapy in drug programs generally apply, adapted to a project that involves only one family member in multifamily groups and provides psychoeducational training rather than therapy. Additional principles include: focusing on family members who live with the client, tailoring recruitment to the needs of individual families, emphasizing how the family member will benefit, addressing resistance directly, helping families to build a support network, and informing family members of what is expected of them. The psychoeducational approach shows promise as a beneficial adjunct to client-focused treatment and as a gateway to more extensive family treatment.     

Family Secrecy in Family Therapy Practice: An Explorative Focus Group Study

The aim of this focus group study was to explore the experiences of family therapists working with family secrecy. Our study highlights that family secrets present important and compelling challenges for family therapists. Furthermore, our study reveals that there seem to be some basic strategies family therapists use in dealing with these challenges in therapy sessions. One basic strategy is that family therapists try to guard their position of being a trustworthy therapist for each family member by avoiding becoming stuck in family secrecy. Furthermore, therapists explore ways to guide the family toward the disclosure of the secret in order to alleviate the toxicity of the secrecy. This highlights the importance of the systemic model and how influential this perspective is in family therapy practice. Some participants, however, have in addition a second strategy they sometimes use: talking with the family about secrecy without aiming to disclose the secret. In the discussion section of the article we reflect on the possibility that in the strategic choices family therapists make conceptual issues might be involved. Furthermore, we stress the importance of further research.     

Manipulation of Verbal Behavior of Chronic Hospitalized Schizophrenics in a Group Therapy Situation

This paper describes a semistructured, time-limited model of group treatment for latency age children. The members, all of whom came from reconstituted families, had a variety of reactive, somatoform, and characterological problems. With help from the therapists, each member constructed his or her own genogram which was then discussed by the group as a whole. Because this format incorporated a technique for mapping family structure into a traditional model of children's group therapy, it focused the group's manifest communication on changing family roles and relationships, both as they had occurred in reality and as they were symbolically reenacted within the group process. Feelings of shame, guilt, anger, and loss were markedly ameliorated as the group members studied the structure of their extended families within an environment which encouraged normative peer interaction and progressive emotional development. A brief review of the recent literature on time-limited, theme centered groups for children is included to provide a context for understanding the group.     

The unraveling of a treatment paradigm: a followup study of the Milan approach to family therapy

A 2-year followup study was conducted to determine the efficacy and degree of satisfaction with Milan-style family therapy with families refractory to other treatment interventions. Fourteen families and 5 couples who received Milan-style family therapy participated in the study. Family outcome was found to be improved in 56% of parents and 89% of identified child-patients at followup. Improved self-outcome at followup was reported by 56% of fathers, 67% of mothers, and 78% of identified child-patients. A substantial percentage of fathers (68%) and mothers (59%) reported that at least one family member sought further therapy posttreatment. Factors associated with either parent's positive perception of the treatment in general included the time interval between sessions, experiencing the treatment as brief rather than long, and positive feelings for the group behind the mirror. Mothers who reported liking the treatment reported better family outcome. For mothers, disliking the treatment was related to family members seeking further treatment. The more negative the mothers' and fathers' spontaneous comments about therapy were, the more likely that a family member would seek further alternative psychotherapy. The outcome results are explained in terms of the treatment families' negative reactions to some aspects of the therapist's stance and to the group behind the one-way mirror, as in Milan-style therapy. The importance of modifying Milan-type therapy to foster a positive attitude toward the treatment procedures and the therapist's interventions is discussed.     

The Family and the School: Utilizing Human Resources to Promote Learning

There is a continuing challenge in our complex society to bridge the gaps that exist between various subsystems. Only by overcoming segmentation can common problems be mutually addressed and the full resources of each subsystem be utilized in finding viable solutions. The project described here brings together members of the family with public school professional staff and a consultant from a family therapy unit. Each system learns from and about the others in an open, sharing environment. The processes of family therapy are utilized with the goals of reversing maladaptive school behavior of children and facilitating constructive interactions both between the family and the school and among school personnel.
The uniqueness in this effort lies in the treatment of the staff of a school as a live, dynamic, interacting system having some of the characteristics of a family. The need for mutual respect on the part of consultant and school personnel is documented. Defining and observing boundaries, clarifying roles and creating a non-critical atmosphere provide the security that permits and encourages individuals to share relevant material within agreed-upon parameters.
Changes in traditional practices have been achieved. School psychologists have taken on new roles while principals and staffs have learned new techniques and skills for relating to each other and for approaching family-based school learning problems. The non-blaming approach recognizes the child as a member of both a family and school organization. Bringing the family and the school together for dialogue and planning unburdens the child as a conveyor of information and values between the two systems. Thus far, there have been substantial benefits from the project to the schools, to the families, and to the body of professional knowledge from which we all learn and grow.     

Assessing Individual Family Members' Constructions of Family Problems

Much contemporary family therapy theory and practice takes into account clients' cognitive constructions of their family problems. Recent calls for therapists to elicit and work with clients' causal explanations and narratives parallel accumulating evidence in the social-clinical literature about the predictive importance of attributions in family relationships. In this article, we introduce the Constructions of Problems Scale (CPS), provide preliminary evidence of its reliability and validity, and suggest ways in which it can be used clinically to reveal new areas for questioning and to generate new ideas. The CPS is a brief questionnaire that can be used to create a profile of each individual family member's private constructions. To complete the CPS, each family member writes a free-form narrative of the presenting problem and then rates his or her perceptions of the contributing causes. The CPS profiles can be used to compare the perspectives of different family members and to assess cognitive constructions at different points in treatment. We discuss its potential for these and other clinical uses.     

Managing Child Behavior Problems in Children With Autism Spectrum Disorders: Utilizing Structural and Solution Focused Therapy With Primary Caregivers

Previous therapeutic models for modifying and managing problem behaviors in children with an Autism Spectrum Disorder have, typically, focused on working directly with the diagnosed child. The exclusion of other family member involvement in treatment displayed a need for creating a systemic model for managing children's problem behaviors. This model proposes Solution Focused Brief Therapy (SFBT) and Structural Family Therapy (SFT) with a focus on the caregivers of children with ASDs to reduce parental stress, increase parental self-efficacy, and ultimately begin to manage child behavior problems.     

The Future of Psychology in Family Medicine

Psychology has been integral to the field of family medicine since its inception as a medical specialty in the 1960s. Psychologists and other behavioral scientists contribute to family medicine in teaching clinical skills, in defining research questions, in developing research methodology, and in creating integrated physical/mental health care delivery systems. Future developments in the field of psychology in family medicine are likely to emphasize development and evaluation of screening measures which identify mental health problems in primary care, development of early intervention for those mental health problems, and more precise measurement of process and quality of care and health outcomes. Psychologists have an important role to fulfill in educating physicians on alternatives to pharmacologic and medical interventions for common presenting problems in primary care. However, current economic forces shaping the practice of medicine may work against further enhancing the efficacy of the physician in dealing with psychosocial issues. The future role of psychology in family medicine is not yet delineated, and while the move toward parity of reimbursement for mental and physical health care delivery may enhance this collaboration, there is a need to continue to evaluate how the psychological well-being of patients is influenced in the evolution of new models of care delivery.