Family Therapy in Outdoor Behavioral Healthcare: Current Practices and Future Possibilities

This paper highlights the role of the family in the treatment of youth who attend Outdoor Behavioral Healthcare (OBH) programs. It discusses the history of OBH, provides a critical overview of the research on the impact of OBH programs on family functioning, and discusses the importance of increased intentional integration of family therapy into OBH settings. To show this integration, this study presents a case study that highlights the role of the family, as well as the home family therapist throughout the phase of OBH treatment. Areas for future esearch are provided as well as suggestions for the increased utilization of adventure activities with families.     

A Family Therapy Narrative

The evolution of the field of family therapy since its inception in the 1950s is traced in this article. Major contributory forces as well as key pioneers in the first generation and leaders in successive generations are highlighted. This is followed by an elucidation of the conceptual foundations and basic principles undergirding almost all of the main theoretical schools. Expansion in this now vast field is underscored through attention to the proliferation of the number of books and journals addressing family therapy/psychology topics as well as mention of the internationalization of the field. A typology of extant theoretical models is also presented. The article closes with a discussion of contemporary issues and trends.     

Brief Cognitive Behavioral Family Therapy Following a Child's Coming Out: A Case Report

Few interventions have been proposed for the treatment of families following a child's disclosure of nonheterosexuality. To address this gap in the literature, the current paper outlines a brief cognitive behavioral family treatment (CBFT) for families negotiating the coming-out process and illustrates this approach with a case example. Parents' attributions, beliefs, and expectations are explored and challenged. The family is exposed to increasingly salient topics and directed to increase the frequency of positive family experiences. Lastly, the family is taught specific listening and problem-solving skills to bolster adaptive family communication. This paper is among the first to apply an empirically supported therapeutic framework to support family adjustment following a child's disclosure of sexual orientation. The potential usefulness and limitations of this CBFT application are discussed.     

Responding to Blame in Family Therapy: A Constructionist/Narrative Perspective

Blaming events (N=25) were identified in seven interviews conducted by prominent theorists who espouse a constructionist or narrative approach to family treatment. Congruent with this perspective, we used conversation analysis (Gale, 1996) and the grounded theory method of constant comparison (Corbin & Strauss, 1990) to identify the therapists’ behaviors and strategies following blame expressed by family members. Results indicated three core categories or themes of therapists’ responses to blame?Ignoring/Diverting, Acknowledging/Challenging, and Reframing?subsuming 17 individual codes (e.g., challenging all-or-none thinking, highlighting neutral information, interrupting, focusing on competence). The most frequent code was focusing on the positive.     

Adolescent Self-Assessment of an Outdoor Behavioral Health Program: Longitudinal Outcomes and Trajectories of Change

Outdoor behavioral healthcare is an increasingly popular treatment modality for adolescents, and evidence suggests that it is effective for a wide range of complex issues. The outdoor behavioral healthcare literature still faces major limitations though, and one of these limitations is that outcomes are primarily measured at only admit and discharge. This study sought to explore the trajectory of change throughout treatment, and investigate outcomes up to 18?months post-discharge. Of the 659 adolescent participants from four outdoor behavioral healthcare programs, 29?% were female, 18?% were adopted, and the average age was 16?years old. Participants were invited to complete questionnaires four times during treatment, and at 6 and 18?months post-discharge. We used multilevel modeling to explore trajectories and predictors of change during treatment, and a regression and an ANOVA to examine outcomes post-discharge. Results of the multilevel modeling supported that adolescents make significant changes during outdoor behavioral healthcare, and also contributed new findings on demographic and diagnostic predictors. Gender and the presence of a mood or anxiety disorder predicted greater rates of change during treatment. Analysis of post-discharge data at six and 18?months post-discharge suggested that clients maintain treatment effects and that gender persists in influencing outcomes. This study is the first to examine trajectories of change in outdoor behavioral healthcare, to find diagnostic variables to be relevant, and to examine self-report outcomes past 12?months post-discharge.     

Using Symbolic-Experiential Family Therapy to Treat Adjustment Disorder: A Case Study

Despite studies claiming Adjustment Disorders (AD) affect up to 10% of the general population, research is severely lacking for effective treatment recommendations and screening tools. This article presents the treatment of a 30-year old Caucasian male diagnosed with AD - mixed anxiety and depression subtype. After 12 standard 60-minute sessions, treatment using a Symbolic-Experiential Family Therapy (SEFT) approach resulted in the alleviation of depression and anxiety symptoms. This case study provides preliminary evidence for the effectiveness of SEFT using a mixed methods case study. Implications for further study, and the usefulness of SEFT for the treatment of AD, is presented.     

Cognitive-Behavioural Therapy Targeting Fear of Progression in an Interdisciplinary Care Program: A Case Study in Systemic Sclerosis

People living with chronic illness often report uncertainty about the future, fear of disease progression, fear of becoming physically disabled, and a reduced life expectancy as important sources of stress. However, little is known about psychological interventions targeting these concerns. The aim of this study is to illustrate an intervention to reduce emotional distress and concerns about the future in a patient with systemic sclerosis (SSc), a rare chronic rheumatic disease with serious consequences for most patients, and to present a preliminary report on its effectiveness using a single-case study design. Because of the complexity of symptoms and complaints due to SSc, the psychological intervention was embedded in an interdisciplinary care program also consisting of physical therapy, occupational therapy, and specialized nurse care.     

Integrating Sex and Couples Therapy: A Multifaceted Case History

Traditionally, sexuality has not been a focus in couples therapy training, research, or practice, although it is an important, often complex issue for many couples. This article tells the story of a couple presenting for sex therapy due to their unconsummated marriage, and is told to exemplify how sex therapy and couples therapy can be integrated in order to best meet the needs of couples. As the story unfolds, the multilayered facets of the presenting issue are revealed. The therapy incorporates and weaves together family of origin history, intrapsychic and cognitive issues, relational dynamics, patterns of interaction, and physiological/medical concerns into a postmodern couples therapy with behavioral interventions. This combined approach recognizes the value of each method on its own and their greater usefulness when blended together.     

Family Therapy Training: Program and Outcome

A family therapy training program has been conducted for staff of mental health agencies located throughout Pennsylvania. This paper is a report on the content and results of the four-year-old training program. Three hundred practitioners have been trained in family therapy. The program has also led to the development of a core group of 64 family therapy trainers. There has been an associated delivery of more family-oriented mental health services throughout the Commonwealth.     

A Narrative Approach to Child and Family Therapy in Africa*

Professional family therapy in Africa is heavily influenced by theories and principles of Western family practice. Its practice structure and philosophies are however grounded on African family values and the principles and orientations of traditional African psychology. This paper presents a clinical report that illustrates adaptations we make to incorporate compatible aspects of narrative family practice in African and Western cultures. A summary of African family values and child psychology intended as a background perspective is provided. The paper is significant against the background of the current need for forging multiculturally relevant healing methods that fit well with the globalized nature of the contemporary world. Augustine Nwoye, PhD, is Associate Professor and Chairman, Department of Psychology, Kenyatta University, Nairobi, Kenya (amnwoye@avu.org). Professor. Nwoye has developed an African paradigm for mental health and, in particular, for family and couple therapy. He also has experience in dealing with stress and multiple losses, especially surrounding HIV/AIDS within an African context. *An earlier version of the paper was presented to the members of staff and students of the Faculty of Education, University of Cambridge, England, UK, and the initial version was presented to the members of the Family Therapy Program of the Faculty of Medicine of the University of Calgary, Calgary, Canada. I wish to thank Dr. Colleen McLaughlin (University of Cambridge) and Professor Karl Tomm (University of Calgary) for their invitation, assistance, time, attention, and suggestions.     

The Use of Strategic Family Therapy in the School Setting: A Case Study

The authors describe a school counselor's shift from a traditional, individualized counseling approach to the use of strategic family therapy as a way of helping a young man succeed in school and leave home.     

Successful Treatment of Olfactory Reference Syndrome With Cognitive Behavioral Therapy: A Case Study

Olfactory reference syndrome (ORS) is characterized by a preoccupation with the belief that one's body emits a foul odor. Cognitive behavioral therapy (CBT) was used to treat a woman in her 50s who presented in our outpatient anxiety disorders specialty clinic with ORS, accompanied by embarrassment, shame, distress, avoidance behavior, and social isolation. Monitoring and systematic reduction of safety behaviors, combined with exposure to anxiety-provoking situations, resulted in elimination of the perceived body odor over the course of ten treatment sessions. Scores on the Overvalued Ideas Scale indicated improvements in the client's insight over the course of treatment, and there was an 82.6% reduction in her preoccupation and compulsive behaviors as measured by the Body Dysmorphic Disorder Yale-Brown Obsessive Compulsive Scale. Indices of depression, anxiety, and stress as measured by the 21-item version of the Depression Anxiety Stress Scales were also reduced from the extremely severe to normal range. These findings suggest further investigation of CBT in the treatment of ORS is warranted.     

Bilateral Art: Integrating Art Therapy,Family Therapy,and Neuroscience

This paper describes the systemic use of a neurologically-based art therapy modality—bilateral art—that engages both dominant and non-dominant hands in the process of creating images in response to opposing cognitions or feelings. It describes both neuroscience and family therapy perspectives that argue for the use of bilateral art. A specific protocol for bilateral art therapy is provided along with a case study demonstrating integration of the protocol into the systemic treatment of a young family. Carole M. McNamee, PhD, is Research Professor and Clinical Associate, Director of the Arts in Healthcare Project, The Family Therapy Center, Department of Human Development, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061 (cmcnamee@vt.edu).     

Application of The Assimilation Model in The Context of Family Therapy: A Case Study

In this case study the aim was to apply the APES (Assimilation of Problematic Experiences Scale) model to the analysis of the family therapeutic treatment process. This was done as a qualitative methodological triangulation in a case of the family of a 10-year old psychotic boy. The study suggests that assimilation model is suitable for many kinds of data in analyzing family therapeutic treatment processes, makes the change more comprehensible, and yields information about the effectiveness of experiential family therapy techniques.     

DBT-Enhanced Cognitive Behavioral Therapy for Adolescent Trichotillomania: An Adolescent Case Study

Results and a case study for a DBT-enhanced habit reversal treatment (HRT) for adult trichotillomania (TTM) (Keuthen & Sprich, 2012) is adapted for use with adolescents. Trichotillomania in adolescence is a very important but understudied problem. Onset often occurs in adolescence, and yet very little treatment research exists. DBT-enhanced habit reversal has shown promise in adult samples (Keuthen et al., 2008) and may prove useful as a model for further study in adolescents. Here, we provide a case study using DBT-enhanced HRT with an adolescent girl. The treatment emphasizes traditional CBT for TTM and also includes a focus on emotion regulation, mindfulness, and distress tolerance to help manage both focused and automatic pulling.