Systemic Treatment of Family Members

This paper analyzes four levels of family dynamics, including family organization, interactive social roles, cognitive factors, and unconscious learnings. Assessment and intervention at each level are summarized in the context of a couple seen for marital therapy. The problems they presented are framed in terms of relevant developmental demands experienced both individually and as a couple. Treatment interventions include modeling, paradoxical assignment, ambiguous function assignment, and therapeutic goal oriented metaphors focusing on attitude, affect, behavior, self image, and family structure change.     

Involving Family Members in the Treatment of OCD

This review focuses on previous research with families of adults and children with obsessive‐compulsive disorder (OCD). Three primary areas of research are covered: (i) characteristics of family members and the family environment; (ii) the prediction of treatment response based on family variables; and (iii) the inclusion of family members in treatment. Much of the research supports a hypothesized model of family response to symptoms of OCD that ranges on a continuum from overly accommodating to overly antagonistic. Further research indicates that responses at either extreme of this continuum are associated with poorer response to both exposure and response prevention (ERP) and pharmacotherapy. Finally, results of preliminary treatment outcome studies suggest that family‐based interventions aimed at reducing such responses and/or including family members in ERP as coaches or co‐therapists may enhance patients' response to treatment. Based on current theory and research, suggestions for future research and general recommendations for involving family members in treatment are made.     

The Aged Are Family Members

Research reveals that the notion of the aged being abandoned or dumped by families is a myth. In general close ties and mutually responsible behavior continue. For those engaged in family treatment, older families and intergenerational relationships are a clinical frontier. Practitioners have the opportunity to experience and observe, in depth, the emotional quality and meaning of intergenerational relations. Older family members may play important roles in the family dynamics. It is hypothesized that their inclusion when appropriate in the treatment of younger families can be a preventive measure to forestall cyclical repetition of pathological relationship patterns. Just as family therapists are committed to the premise that many nuclear families are capable of psychological growth and change, they must become aware that aged family members have similar capacities. If intergenerational relationships are modified then family members in all the generations could be benefited.     

结构式家庭治疗在精神分裂症患者中应用的研究概况

精神分裂症属于重性精神病,在世界人口中的患病率约为1％,其特点是病程迁延,治疗进展缓慢,且复发率以及病残率均相对较高.它是一类病因尚未完全明了的精神障碍,社会心理因素(尤其是家庭关系)在其发病、转归和预后方面具有重要作用.针对精神分裂症家庭特点的研究,推动了家庭治疗的发展,也增加了帮助患者全面康复的治疗手段.结构式家庭治疗假设家庭中被标定的个体的问题与家庭的动力和结构有着密切的联系,改变家庭的动力及其组织过程,可改变个人及家庭,可以应用于精神分裂症患者家庭中,并且具有良好的治疗效果.     

Schizophrenia and the Family: II. Adverse Effects of Family Therapy

Theoretical formulations of the past thirty years have championed the hypothesis that family interaction contributes heavily to the etiology of schizophrenia, a position that has dominated contemporary family therapy even in the absence of solid empirical confirmation. The possibility that sociogenic modeling of schizophrenia is not only incorrect but even harmful to families, and to the relationship between families and clinicians, has never been taken seriously, despite its implications for the practice of family therapy. The author describes untoward effects of the sociogenic hypothesis in his own ten-year experience with families of chronic schizophrenics and examines pertinent reports in the family therapy literature, offering the reinterpretation that many communicational aberrations are adaptations to two therapist attributes: (a) failure to absolve the family of initial causal responsibility, and (b) failure to inform the family about the nature of the illness.     

Development of a Brief Adjunctive Intervention for Family Members of Veterans in Individual PTSD Treatment

Family involvement in the treatment of posttraumatic stress disorder (PTSD) among veterans has the potential to improve treatment retention and outcomes. Current protocols that incorporate family members into treatment tend to involve at least 15 sessions, and none are designed to complement Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE), the two most widely used and heavily promoted evidence-based PTSD therapies in the Veterans Affairs (VA) healthcare system. The current paper describes the development and initial feasibility and acceptability of a Brief Family Intervention (the BFI) designed to be delivered as an adjunct to veterans’ individual CPT/PE. The BFI focuses on providing psychoeducation about PTSD and treatment, building family member support for treatment, and reducing family symptom accommodation. A detailed review of the treatment structure and activities is provided, and qualitative data from four dyads (veterans and their spouses/significant others) at baseline and post-intervention are presented. Veterans and partners reported positive responses to the program and were enthusiastic about its utility. Larger randomized controlled studies will be needed to determine the protocol’s efficacy and effectiveness.     

Occupational Therapy in the Treatment of Schizophrenia

A review of Occupational Therapy literature on the treatment of schizophrenia identified four loosely defined treatment categories: (1) sensory integration, (2) activity groups, (3) social skills training, and (4) living skills training. From available data is appears that sensory integration therapy has been able to improve the motivation and affect of schizophrenic patients and structured activity programs can contribute to a reduction in positive symptomatology. Social and living skills training show promise as treatment methods to promote the community functioning of this population. A future need to establish which schizophrenic patients and what schizophrenic symptomatology respond to different types of treatment is identified.     

Differences in Self-Report Among Incest Family Members

A questionnaire study was conducted among incest families to study their perceptions of social background factors, how long the incest relationship lasted, who was involved, the history of incest in the family, emotional and psychological factors, and the consequences of the incest for the family. It was hypothesized that incest offenders, their spouses and incest victims all tend to report the above in a manner that reflect positively upon their own role in the incest relationship. The results showed clear differences in the reposts of the three groups. The paper concludes that such differences in perceptions must be incorporated in family therapy strategies as well as in our knowledge base of incest families.     

Race-Related Differences in the Experiences of Family Members of Persons with Mental Illness Participating in the NAMI Family to Family Education Program

Families play an important role in the lives of individuals with mental illness. Coping with the strain of shifting roles and multiple challenges of caregiving can have a huge impact. Limited information exists regarding race-related differences in families’ caregiving experiences, their abilities to cope with the mental illness of a loved one, or their interactions with mental health service systems. This study examined race-related differences in the experiences of adults seeking to participate in the National Alliance on Mental Illness Family-to-Family Education Program due to mental illness of a loved one. Participants were 293 White and 107 African American family members who completed measures of problem- and emotion-focused coping, knowledge about mental illness, subjective illness burden, psychological distress, and family functioning. Multiple regression analyses were used to determine race-related differences. African American caregivers reported higher levels of negative caregiving experiences, less knowledge of mental illness, and higher levels of both problem-solving coping and emotion-focused coping, than White caregivers. Mental health programs serving African American families should consider targeting specific strategies to address caregiving challenges, support their use of existing coping mechanisms and support networks, and increase their knowledge of mental illness.     

Researching the Family Theories of Schizophrenia: An Exercise in Epistemological Confusion

Some, but not all, of the family theories of schizophrenia entail a shift from the Aristotelian/Cartesian/Newtonian epistemology of individual psychology to a systemic epistemology of pattern. Perhaps the most significant (and underappreciated) aspect of this epistemological shift pertains to etiology: The family theories of schizophrenia espoused by Bateson et al. and by Wynne and Singer do not claim that parents or families cause schizophrenia. The persistent failure of researchers to appreciate this has led to many fruitless studies that have sought to discover a causal link between the thought disorder and communication deviance of parents and the schizophrenia of their offspring. This paper reviews from an epistemological viewpoint the empirical literature that has attempted to assess the validity of the family theories of schizophrenia. Particular attention is given to restating and extending the epistemology of pattern within which schizophrenia occurs. The conventional psychiatric approaches to schizophrenia are shown to play an active role within the schizophrenic pattern.     

Psychoeducational Multiple Family Groups: Four-Year Relapse Outcome in Schizophrenia

Earlier studies of family psychoeducation and clinical reports on multiple family groups (MFGs) have reported substantial reductions in relapse rates for patients with schizophrenia. These groups offer an expanded social network and thereby may confer a margin of protection against relapse. However, to date, there has not been an empirical trial of this modality. The advent of family psychoeducational and behavioral management strategies provided the basis for an experimental, three-way comparison of psychoeducational MFGs to psychoeducation in a single-family format and to MFGs without psychoeducation, using symptomatic relapse as the outcome criterion. After 4 years, the psychoeducational MFGs were significantly more effective in extending remission than the single-family format, while the MFGs without psychoeducation approximated outcome in the psychoeducational MFGs. The respective relapse rates at 4 years were 50%, 78%, and 57%; MFGs averaged 12.5% and 14% per year. These results point toward an enhanced and independent, long-term therapeutic effect for multiple family groups, when combined with antipsychotic medication and psychoeducation, with especially promising cost-effectiveness.     

Reuniting Estranged Family Members: A Cognitive-Behavioral-Systemic Perspective

During the course of their clinical work, couple and family therapists may encounter situations in which family members have become estranged. While some of these estrangements have to do with reasons beyond family members’ control, such as adoptions, etc., many cases are primarily the result of deliberate separation over hurt feelings sparked by disputes. This article offers an integrated approach, combining cognitive-behavioral techniques with an integrated family systems strategy for reuniting estranged family members. An extended case example illustrates specific interventions, with a discussion section addressing the challenges and pitfalls that may be encountered in the process of healing family feuds.