Counseling Caregivers of Families Affected by HIV/AIDS: The Use of Narrative Therapy

This article proposes the use of Narrative Therapy with family caregivers of family members diagnosed with HIV/AIDS. The authors identify the reasons for using Narrative Therapy with African family caregivers who have relocated to the United States of America. The tenets of Narrative Therapy are outlined, and a case illustration is provided to show how Narrative Therapy can be implemented. In this case study, the client moves from a state of helplessness and hopelessness to being able to regain control of her life and improve the care of her sister. She was able to re-write her story: from feeling incompetent to a position of strength. Although Narrative Therapy was used successfully with an African family caregiver within the USA, the authors assert that the interventions have the potential to be used as effectively with those clients living in Africa, provided counselors are sensitive to cultural differences that will affect their practice.     

青少年网络成瘾的预防与干预研究

网络成瘾障碍(Internet Addiction Disorder,IAD)已成为影响青少年身心健康和正常学业表现的重要因素。针对青少年网络成瘾的心理预防与干预研究已开展逾十年,分析与总结显示,已有研究采用个体、团体等不同干预模式,采用认知行为、动机激发等不同咨询与治疗理论,对青少年网络成瘾行为的干预进行了大量探索;其中以团体干预模式及认知行为疗法为主导,并呈现多模式多理论相融合的趋势。借鉴已有研究的成果与不足,我们采用家庭治疗、认知行为、动机激发等多种咨询与治疗理论,结合心理需求网络满足优势等网络成瘾理论,形成了个体-家庭-学校的多水平预防与干预方案,并得到了实证研究的检验。今后的研究应进一步考虑青少年网络成瘾的生理因素,将生物-心理-社会三方面相结合形成系统性的网络成瘾预防与干预模式。     

Reflections on Family Therapy in Australia

Family therapy in Australia has been influenced by ideas mostly from North America and Europe. However Australian family therapists have also made their own significant contributions to theory and practice. The vastness of the continent combined with a relatively small population has presented challenges with respect to the formation of a national association and for many years, the Australian Journal of Family Therapy (later the Australian and New Zealand Journal of Family Therapy Board acted as de facto national voice for the discipline. The Australian Association of Family Therapy was formed as recently as 2011. It has a total of over 1,000 members and is the sole organisation representing family therapy and family therapists in Australia. Clinical membership is achieved via successful completion of a 2-year sequence of study in family therapy followed by 50 hours of supervision (or its equivalent). Family Therapy training is mostly delivered in the four most populated states in Australia at both University level and through private organisations registered to provide training at government approved levels. La Trobe University (through the Bouverie Centre), Swinburne University (through the Williams Road Family Therapy Centre) and the University of New South Wales currently provide training leading to specialist qualification in family therapy. A number of other private institutions also provide recognised family therapy training. To date, family therapists and couple therapists in Australia have not in the main shared common platforms such as conferences, training and professional journals. Narrative therapy has also remained somewhat detached from “mainstream” family therapy. Family therapy qualifications are often valued by prospective employers even when duty statements are focused on the more traditional skills of professionals such as psychologists or social workers. Researching family therapy outcomes remains challenging. But although there is increasing practiced-based evidence of the efficacy of family therapy, Australian family therapists as a group are yet to concentrate their efforts on convincing funding bodies of its usefulness. At the same time, via the teaching and promotion of family sensitive practices, systemic ideas are being increasingly incorporated within areas of mental health, disability, alcohol and drug dependency, and within a range of health and welfare areas that impact not just on the individuals but on those close to them.     

Non-suicidal Self-Injury (NSSI): A Case for Using Emotionally Focused Family Therapy

Non-suicidal self-injury (NSSI) is defined by engaging in self destructive behaviors specifically targeted toward the body without suicidal intent. It is a mental health phenomenon increasing in occurrence. Marriage and family therapists will need to know how to treat this clinical presentation, as it is gaining recognition as a diagnostic category in the 2013 Diagnostic and Statistical Manual used to identify mental illness. This paper provides background information about NSSI, and includes an argument for testing the treatment of this disorder with Emotionally Focused Family Therapy. A clinical example is included.     

Taming the Brain Weasels: Reducing Self-Criticism Through Externalization and Compassion

ABSTRACT

Self-criticism is a natural process occurring across mental health disorders. When self-criticism is excessive, vulnerability to mental health disorders such as depression and anxiety increases. Compassion-focused approaches can effectively address a variety of concerns; however, highly self-critical individuals might balk at the idea of self-directed compassion due to shame, self-blame, or discomfort with positive emotions, resulting in treatment resistance. The brain weasel is an intervention strategy that uses the Narrative Therapy technique of externalization as an intermediate step toward compassion-oriented work. Through creative externalization and therapeutic humor, self-critical individuals can decenter and explore their self-critical dialogue. This article contains several ways to introduce and use the brain weasel personification in counseling.     

Family Treatment Approaches for Depression in Adolescent Males

Adolescent depression is a serious and common disorder. Though adolescent males are less likely to report depression than females, they have serious risks associated with the disorder, like suicide, future substance abuse, and illegal activity. Several gender differences have been observed among depressed adolescents and should be considered in assessment and treatment. Little efficacy research exists for family treatments of depression in adolescent males, though several approaches have been proposed. These approaches include Structural Family Therapy, Interpersonal Family Therapy, and Attachment-Based Family Therapy. These treatments have been found useful in clinical settings, but much more efficacy research is necessary.     

Cyberbullying status and mental health in Norwegian adolescents

The aim of the present study was to examine how the cyberbullying status (not involved, cyber-victim only, cyberbully only, cyber-victim and bully) is related to the mental health of the adolescents when controlled for traditional bullying experience. We also examined the potential moderator sex on the relationship between cyberbullying status and mental health. Univariate analyses of variance were conducted to predict mental health problems using the Strength and Difficulties Questionnaire total difficulties score and its five scales. The model consisted of five predictors in addition to an interaction term between cyberbully status and sex. Of the 2,117 adolescents, 50% were girls. The vast majority did not have any cyberbullying experience (87%), 9% of the adolescents were cyber-victims only, 1% were cyberbullies only and 3% were both cyber-victims and bullies. Overall, girl's mental health seems to be more compromised when exposed to or involved in cyberbullying than boys mental health. In general, adolescents who are not only cyberbullies and cyber-victims, but also cyber-victims only had a worse mental health compared to adolescents without cyberbullying experience. Being exposed to cyberbullying is a unique contributor to mental health problems. Preventing cyberbullying is therefore important. Especially girl's mental health seems to be negatively affected when exposed to cyberbullying.     

Multisystemic Therapy and Functional Family Therapy Compared on their Effectiveness Using the Propensity Score Method

Multisystemic Therapy (MST) and Functional Family Therapy (FFT) have overlapping target populations and treatment goals. In this study, these interventions were compared on their effectiveness using a quasi-experimental design. Between October, 2009 and June, 2014, outcome data were collected from 697 adolescents (mean age 15.3 (SD 1.48), 61.9% male) assigned to either MST or FFT (422 MST; 275 FFT). Data were gathered during Routine Outcome Monitoring. The primary outcome was externalizing problem behavior (Child Behavior Checklist and Youth Self Report). Secondary outcomes were the proportion of adolescents living at home, engaged in school or work, and who lacked police contact during treatment. Because of the non-random assignment, a propensity score method was used to control for observed pre-treatment differences. Because the risk-need-responsivity (RNR) model guided treatment assignment, effectiveness was also estimated in youth with and without a court order as an indicator of their risk level. Looking at the whole sample, no difference in effect was found with regard to externalizing problems. For adolescents without a court order, effects on externalizing problems were larger after MST. Because many more adolescents with a court order were assigned to MST compared to FFT, the propensity score method could not balance the treatment groups in this subsample. In conclusion, few differences between MST and FFT were found. In line with the RNR model, higher risk adolescents were assigned to the more intensive treatment, namely MST. In the group with lower risk adolescents, this more intensive treatment was more effective in reducing externalizing problems.     

Expanding Our Reach: Marriage and Family Therapists in the Public School System

As states change their legislation to include Marriage and Family Therapists (MFTs) as approved mental health providers in schools, it is important to understand the experiences of MFTs in this context to improve training and increase our effectiveness. MFTs with experience working in public schools (N = 21) discuss the advantages and rewards of working in schools, challenges they have experienced, how they have dealt with those challenges, and training they recommend for MFTs seeking to work in schools. Qualitative results have implications for practitioners, training, and supervision. The possibility of a specialization in School-Based Family Therapy is discussed.     

Family Therapy Techniques in Residential Settings: Family Sculptures and Reflecting Teams

Outcome data has shown that family therapy is highly effective in the treatment of many disorders including addiction, mood, and other issues. In working to make treatment as effective as possible, many residential treatment and outdoor behavioral healthcare (OBH) programs have adopted family therapy techniques for use in individual and peer group therapy settings. Some have also incorporated family members by inviting them to visit the residential setting and participate in treatment exercises. An article by Faddis and Bettmann (J Ther Sch Program 1(1): 57–69, 2006) outlines an example of this integrated approach to family sculptures and reflecting teams in a wilderness therapy setting for adolescents. This integrated technique has since come to be known as the four phase Familial Sculpting and Reflecting intervention. Most recently these methods have been expanded for use with young men ages 18–30 in an adventure wilderness therapy program. This article will examine the theoretical basis for both of these approaches, discuss the application of these techniques to residential OBH programs and review how these methods have been most recently adapted for use in another program.     

Family Experience of Safe: A New Intervention for Families of Children with a Diagnosis of Autism Spectrum Disorder

Systemic Autism-related Family Enabling (SAFE) is a new intervention for families of children with a diagnosis of Autism Spectrum Disorder (ASD). SAFE responds to international and national recommendations for improved care and the reported needs of families. SAFE draws from Family Therapy techniques, Attachment Narrative Therapy and known preferences of individuals with autism. Twenty two families of a child with a diagnosis of ASD severity level 1 or 2 were recruited. The families attended five 3-hour sessions. Family members completed the Helpful Aspects of Therapy Questionnaire (HAT) after each session. Analysis of the HAT data revealed that adults and children experienced SAFE to be helpful which was elaborated in terms of the following themes: therapist as helping reflection, increased understanding, feeling closer, more confident to reflect and problem solve, improved communication and feeling less alone and isolated. The findings are discussed to consider how SAFE can be improved and implemented to offer support for families. SAFE is a good candidate to fill a gap in autism related care.

     

Book Reviews

Books reviewed:
E. Jones and E. Asen, Systemic Couple Therapy and Depression
Alan Carr, Family Therapy. Concepts, Process and Practice
Torben Marner, Letters to Children in Family Therapy: A Narrative Approach
David Campbell, The Socially Constructed Organization
Gitte Haslebo and Kit Nielsen, Systems and Meaning – Consulting in Organizations
Christopher Clulow (ed.), Adult Attachment and Couple Psychotherapy, The 'Secure Base' in Practice and Research
C. Everett Bailey (ed.), Children in Therapy – Using the Family as a Resource     

Identification of adolescent sexual offenders: A rebt model

The adolescent sexual offender is perhaps one of the most misunderstood, misdiagnosed and maltreated clinical populations facing today's mental health practitioner. They are often the adolescents whom no one wishes to have in their family, school, neighborhood and, sometimes, office. Since this clinical population is relatively new and research has yet to establish consistent findings, attempts to categorize these adolescents are often subjective and inaccurate. This article outlines the problems in traditional diagnostic schemes for identifying adolescent sexual offenders, the myths surrounding the predisposing factors for becoming an adolescent sexual offender, the rationale and process based on Rational Emotive Behavior Therapy (Ellis, 1962) for identifying adolescent sexual offenders and how to discriminate this group from adolescents who engage in inappropriate sexual behavior. These two classifications are the two categories for identifying the adolescent sexual offenders for our program at Children's Service Center in Wilkes-Barre, Pennsylvania. The Children's Service Center adolescent sexual offender program currently has a zero recidivism rate for the past four years.     

The Effects of a Multiple Family Therapy on Adolescents with Eating Disorders: An Outcome Study

Multiple Family Therapy (MFT) has gained increasing popularity in the treatment of eating disorders and many programs have been developed over the past decade. Still, there is little evidence in the literature on the effectiveness on MFT for treating eating disorders. The present study examines the effects of a particular model of Multiple Family Therapy on eating disorder symptoms, quality of life, and percentage of Expected Body Weight (%EBW) in adolescents with eating disorders (ED). Eighty‐two adolescents with ED, aged between 11 and 19 years, were assessed before and after treatment using the Eating Disorders Inventory 2 (EDI‐2), the Outcome Questionnaire 45 (OQ‐45) and %EBW. Results showed a significant increase in %EBW between the beginning and end of treatment, with a large effect size. 52.4% of patients achieved an EBW above 85%. Symptoms relative to all EDI dimensions (except for bulimia) significantly decreased during treatment. The three dimensions related to quality of life assessment also improved over the course of MFT. At the end of treatment, 70.7% of patients had a total OQ‐45 score below clinical significance. This study suggests that Multiple Family Therapy may benefit adolescents with eating disorders, with improvement on several outcome measures (%EBW, ED symptoms, and quality of life). However, the lack of a comparison group entails caution when drawing conclusions.     

Mothers’ Mental Health Treatment Associated with Greater Adolescent Mental Health Service Use for Depression

Despite concerns surrounding depression in adolescence and the existence of effective treatments, adolescent depression often goes untreated. In 2014, only 41.2% of adolescents experiencing a major depressive episode (MDE) received mental health treatment. Parents play a key role in adolescents’ treatment utilization. We examined whether among mothers with any mental illness, mothers’ utilization of mental health treatment was associated with greater likelihood of their adolescent children who experienced an MDE receiving mental health treatment. Using nationally representative data from the National Survey on Drug Use and Health (2008–2014), we performed logistic regression analysis to model the odds of adolescents (aged 12 to 17 years) with a past year MDE receiving any mental health treatment in the past year as a function of their mothers’ mental health treatment utilization in the past year, adjusting for control variables. The rate of adolescent treatment utilization was 66% when mothers had utilized treatment, as compared to 45% when mothers did not utilize treatment (p?<?0.001). The odds of an adolescent with an MDE receiving mental health treatment were two times greater when the mother received mental health treatment as compared to adolescents whose mothers did not receive any mental health treatment (OR?=?2.09, 95% CI [1.04, 4.17]). There was no effect of adolescent gender (OR?=?1.15, 95% CI [0.40, 3.28]) or interaction between gender and mothers’ treatment (OR?=?0.95, 95% CI [0.26, 3.46]). Barriers to adolescent mental health treatment may be lower when mothers receive mental health treatment.     

Multidimensional Family Therapy HIV/STD Risk-Reduction Intervention: An Integrative Family-Based Model for Drug-Involved Juvenile Offenders

Drug and juvenile justice involved youths show remarkably high rates of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) risk behaviors. However, existing interventions aimed at reducing adolescent HIV risk behavior have rarely targeted these vulnerable young adolescents, and many approaches focus on individual-level change without attention to family or contextual influences. We describe a new, family-based HIV/STD prevention model that embeds HIV/STD focused multifamily groups within an adolescent drug abuse and delinquency evidence-based treatment, Multidimensional Family Therapy (MDFT). The approach has been evaluated in a multisite randomized clinical trial with juvenile justice involved youths in the National Institute on Drug Abuse Criminal Justice Drug Abuse Treatment Studies ( http://www.cjdats.org ). Preliminary baseline to 6-month outcomes are promising. We describe research on family risk and protective factors for adolescent problem behaviors, and offer a rationale for family-based approaches to reduce HIV/STD risk in this population. We describe the development and implementation of the Multidimensional Family Therapy HIV/STD risk-reduction intervention (MDFT-HIV/STD) in terms of using multifamily groups and their integration in standard MDFT and also offers a clinical vignette. The potential significance of this empirically based intervention development work is high; MDFT-HIV/STD is the first model to address largely unmet HIV/STD prevention and sexual health needs of substance abusing juvenile offenders within the context of a family-oriented evidence-based intervention.     

Relationships,Environment, and the Brain: How Emerging Research is Changing What We Know about the Impact of Families on Human Development

Recent research is providing family therapists with new information about the complex interaction between an individual's biological makeup and his/her social and physical environment. Family and social relationships, particularly during sensitive periods early in life, can affect a child's biological foundation. Additionally, stress during the early years can have a lasting effect on an individual's physical and mental health and contribute to the onset of severe mental illness. Community programs have been developed to intervene early with families who have an at‐risk child to prevent or minimize the onset of mental illness including providing partnerships with at‐risk mothers of infants to shape attachment relationships. Programs are also developing individual and family interventions to prevent the onset of psychosis. Practicing family therapists can incorporate emerging neuroscience and early intervention research and leverage the growing base of community programs to enhance the effectiveness and sustainability of mental health outcomes for clients. Additionally, family therapy education programs should broaden student training to incorporate the growing body of information about how family relationships affect individual mental health development.     

The Effectiveness of Functional Family Therapy in Reducing Adolescent Mental Health Risk and Family Adjustment Difficulties in an Irish Context

To evaluate the effectiveness of Functional Family Therapy (FFT) 42 cases were randomized to FFT and 55 to a waiting‐list control group. Minimization procedures controlled the effects of potentially confounding baseline variables. Cases were treated by a team of five therapists who implemented FFT with a moderate degree of fidelity. Rates of clinical recovery were significantly higher in the FFT group than in the control group. Compared to the comparison group, parents in the FFT group reported significantly greater improvement in adolescent problems on the Strengths and Difficulties Questionnaire (SDQ) and both parents and adolescents reported improvements in family adjustment on the Systemic Clinical Outcomes and Routine Evaluation (SCORE). In addition, 93% of youth and families in the treatment condition completed FFT. Improvements shown immediately after treatment were sustained at 3‐month follow‐up. Results provide a current demonstration of FFT's effectiveness for youth with behavior problems in community‐based settings, expand our understanding of the range of positive outcomes of FFT to include mental health risk and family‐defined problem severity and impact, and suggests that it is an effective intervention when implemented in an Irish context.     

Impact of Caregiver Factors on Youth Service Utilization of Trauma-Focused Cognitive Behavioral Therapy in a Community Setting

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an increasingly available evidence-based therapy that targets the mental health symptoms of youth who have experienced trauma. Limited research has examined how to engage and retain families in TF-CBT services in community settings. Using a mixed-methods approach, the goal of this exploratory study was to identify caregiver factors that impact youth enrollment and completion of community-delivered TF-CBT. The study included 41 caretakers of youth referred to therapy at a local child advocacy center following a forensic assessment substantiating youth trauma exposure. Caregiver factors examined include caregiver demographics, trauma exposure, and mental health symptomology. Results from multivariate logistic regressions indicate that caregivers reporting more children residing in the household were significantly more likely to enroll youth in therapy (OR 2.27; 95 % CI 1.02, 5.03). Qualitative analyses further explicate that parents with personal trauma or therapy experiences expressed positive opinions regarding therapy services for youth, and were more likely to enroll in or complete services. Findings suggest that caregivers with personal traumatic experience and related symptomatology view therapy as important and are more committed to their child receiving therapy. Future research on service utilization is warranted and should explore offering parental psychoeducation or engagement strategies discussing therapy benefits to parents who have not experienced trauma and related mental health symptomatology.     

Book Reviews

Books Reviewed in this article:
Eia Asen, Neil Dawson, and Brenda McHugh, Multiple Family Therapy: The Marlborough Model and its Wider Applications
C Christian Beels, 'A Different Story…': The Rise of Narrative in Psychotherapy