Family therapy vs. parent groups: Effects on adolescent drug abusers

Abstract

The families of adolescent drug abuse clients who were admitted to six outpatient drug-free (OPDF) treatment programs were randomly assigned to either a family therapy method or a parent group method. It was later found that in 93% of the family therapy families, one or both parents participated (N=85); but that in only 67% of the families assigned to a parent group did one or both parents participate (N=50). This is considered to be an important practical advantage for family therapy. At follow-up evaluation 15 months later (after a 6-month course of treatment and a 9-month follow-up period), the clients and their mothers in both groups reported significant improvement on numerous outcome criteria, including reduction in substance use. There was no significant difference between the two groups in degree of improvement.     

Healing Intergenerational Wounds: An Integrative Relational–Neurobiological Approach

Old resentments and unfinished business from the family of origin can constrain adults in current relationships with parents or siblings and negatively affect relationships with partners or children. This article explores how old wounds get reactivated in current relationships and contribute to the intergenerational transmission of painful legacies and trauma. Building on intergenerational family theory and interpersonal neurobiology, the dynamics of reactivity and pathways for growth are explored. While much of the time the human brain is on autopilot, driven by habits and emotional reactivity, we are capable of bringing prefrontal thoughtfulness and choice to close relationships. Rather than being victims of parents or our past, we can become authors of our own relational life. Interventions are offered to help adult clients “wake from the spell of childhood,” heal intergenerational wounds, and “grow up” relationships with family of origin. The damage caused by parent‐blaming in therapy is explored and contrasted with Ivan Boszormenyi‐Nagy's emphasis on rejunctive action and cultivating resources of trustworthiness in intergenerational relationships. The family is considered both in its cultural context—including stressors and resources for resilience—and in its life cycle context. Aging in the intergenerational family is discussed, focusing on ways adult children and their parents can grow and flourish with the challenges at this time of life. Throughout, the theme of relational ethics—how we can live according to our values and “reach for our best self” in intergenerational relationships—informs the discussion.     

Ambivalence and Alliance Ruptures in Cognitive Behavioral Therapy for Generalized Anxiety

Client ambivalence about change (or motivation) is regarded as central to outcomes in cognitive behavioral therapy (CBT). However, little research has been conducted to examine the impact of client ambivalence about change on therapy process variables such as the therapeutic alliance. Given the demonstrated limitations of self-report measures of key constructs such as ambivalence and motivation, the present study instead employed a newly adapted observational measure of client ambivalence. Client statements regarding change (change talk (CT) and counter-change talk (CCT)) were coded in early (session 1 or 2) therapy sessions of CBT for generalized anxiety disorder. The frequency of CT and CCT was then compared between clients who later experienced an alliance rupture with their therapist, and clients who did not. The results showed that clients in dyads who later experienced an alliance rupture expressed significantly more CCT at the outset of therapy than clients who did not later experience an alliance rupture. However, CT utterances did not significantly differ between alliance rupture and no-rupture groups. CCT may strain the alliance because clients expressing higher levels of CCT early in therapy may be less receptive to therapist direction in CBT. Consequently, it is recommended that clients and therapists work together to carefully address these key moments in therapy so as to prevent alliance rupture and preserve client engagement in therapy.     

Outcomes of systemic/strategic team consultation: II. Three-year followup and a theory of "emergent design"

This is the second in a series of articles on an experimental, small-sample study of systemic/strategic team consultations. It presents the 3-year outcomes of clients whose 1-month progress was described in an earlier report (12). The 8 therapists in the current study originally were asked to select two ongoing cases matched for difficulty (N = 16). While all cases continued their regular therapy sessions, one of each therapist's two cases were selected at random to participate in a "Milan-informed," five-part team consultation. At 3-year followup, clients who participated in team consultations had maintained significantly higher levels of goal attainment than nonteam clients (p less than .05). For interpreting these results, we propose a developmental theory ("emergent design") to explain therapy impasses, team effects, the impact of termination, and long-range outcomes of therapy.     

A Case-Series of Reflective Family Play: Therapeutic Process,Feasibility, and Referral Characteristics

Evidence-based interventions for infants and preschoolers, and their families, have largely focused on the mother-child dyad. In response to the increasing need to diversify treatment approaches in the under six population and include the whole family system, we have developed a new treatment approach called Reflective Family Play (RFP). A manualized, whole-family therapy, RFP allows for the involvement of two parents and siblings when working with infants or young children. In this case-series, we used a qualitative chart review to examine the therapeutic process, acceptability, and feasibility of RFP for 22 families with children ages 0–6, who participated in RFP. We also sought to better understand the referral characteristics of those families who participated in RFP by comparing them to families who were referred to and participated in an established dyadic approach during the same time-period. Session-by-session coding of clinician chart notes revealed evidence of positive shifts throughout the RFP process, including more whole-family play, improvements in coparenting, and better parental mentalization. Parents reported improvements in presenting concerns in all but one case. Improvements in coparenting, sibling relationships, and family alliance were also reported by parents after RFP. Clinical implications and directions for future research are discussed.     

Audit and family systems consultation: evaluation of practice at a child and family centre

This audit of practice at a child and family centre included a 16-month case note review covering 319 cases, a postal survey of 45 families and an interview survey of ten GPs who typically referred cases to the centre. The audit furnished information from three different perspectives on the referral process, the consultation process, and outcome for clients attending the centre. The referral rate was about one new case per day and peak referral times were the beginning of the autumn and winter school terms. Almost half the referrals came from GPs; the remainder were largely from Paediatrics, Education and Social Services. Most clients were seen within two months. Half of the families referred had serious psychosocial difficulties including multiple problem members, multi-problem children, multi-agency involvement, psycho-educational difficulties, child protection problems or child placement difficulties. The majority of cases received six hours of consultation. Families where child abuse had occurred or families containing a multi-problem adolescent received a more intensive service. Between a half and three-quarters of cases had positive outcomes as rated by staff and parents. The service was viewed by GPs to be highly satisfactory. On the negative side, many parents felt ill-prepared for the consultation process and most children did not enjoy the experience.     

Outcomes of systemic/strategic team consultation: I. Overview and one-month results

This is the first in a series of reports on an experimental, small-sample study of systemic/strategic team consultations. This report describes a "Milan-informed" method of team consultation for resolving therapy impasses. It then focuses on the initial one-month outcomes from the larger 3-year project. Eleven therapists were asked to select two ongoing cases matched for difficulty. While all cases continued in regular therapy, one of each therapist's cases was also selected at random to participate in a systemic/strategic, five-part team consultation. Analyses of one-month follow-up data showed that clients who participated in the team consultation were more likely to achieve their main and overall treatment goals than clients who received only regular therapy (p's less than .05, eta2 as a measure of effect size ranging from 32% to 41%). The strong findings of this initial study encourage more widespread use of team consultations as a context for treatment, training, and research.     

A family therapy perspective on mediation

Many times, family therapists are both the first to learn that a couple may separate and the last to see them in the same consultation room, still relating to each other and the same professional before the adversarial system takes over. Mediation offers a viable alternative to that system because clients are helped to speak directly and craft the decisions that will delineate their move toward separate lives. Mediation is defined and the divorce process demystified, and the similarities and differences between mediation and therapy are discussed. Brief examples and a longer case discussion are provided to illustrate the mediation process. A familiarity with this process will enable therapists to hold more informed discussions about mediation with their clients and invite them to consider a process that is congruent with many of the values of family therapy.     

家庭氛围、子女生活满意度与心理健康代际传递的关系：亲子性别和子女年龄的差异

为探讨家庭环境（家庭氛围）、认知过程（生活满意度）和个人因素（亲子性别和子女年龄）对心理健康代际传递的影响,对591户家庭亲子被试进行调查。结果显示：（1）父母心理健康均正向预测子女心理健康,家庭氛围和子女生活满意度在其中起了重要中介作用;（2）较之于父亲,母亲心理健康对家庭氛围的预测效应更显著,母亲能以家庭氛围和生活满意度为链式多重中介预测子女心理健康,父亲心理健康仅以生活满意度为中介预测子女心理健康;（3）母亲心理健康仅能直接预测女儿的生活满意度和心理健康,父子间代际传递效应高于父女,以及母亲对子女的影响效应随子女年龄增长而提高,父亲的影响效应却在下降。研究结果有助于揭示心理健康代际传递的作用机制,且可丰富心理健康领域的研究。     

The developmental course of Personal Authority in the Family System

The present study examined the differences in participants' intergenerational family relationships across the following three age/stage groups based on Williamson's (1991) theory of Personal Authority in the Family System (PAFS) and adult developmental theory (Levinson, 1986): ages 18-23, 24-29, and 30-45. The most noteworthy variables were intergenerational intimacy and intimidation with mothers and fathers, with significant but less contribution by intergenerational triangulation with fathers. Results indicated that each successively older group reported significantly less intimacy and less intimidation with each parent, and less triangulation with fathers than the previous younger group. Small gender differences were also present, but without an interaction with age/stage groups. Females reported slightly healthier intergenerational relationships with parents than did males. Finally, implications for clinical practice are presented.     

Learning and Living Systemic: Exploring the Personal Effects of Family Therapy Training

Despite growing recognition that systemic family therapists need to be adept at personal reflection and managing the therapeutic relationship, little research has explored the effects of training beyond the development of skills. This article provides a report on a qualitative study focussed on the personal effects of family therapy training, with particular reference to the aspects of training that foster personal reflection and growth. Twenty three trainees from three training institutions were interviewed, utilizing the practices of grounded theory. Trainees reported a deepening relational awareness, which applied to both personal and professional domains and included shifts in perspectives on relationships with loved ones. Five aspects of training were identified as responsible: (1) personally challenging experiences with clients; (2) supervisors who live the paradigm; (3) the demystification of theory; (4) a safe supervisory space; and (5) the development of trusting peer relationships. Interns also described, in turn, how their personal development affected their clinical work, particularly in the development of compassion and empathy. This study serves to highlight training practices that support reflective practice in systemic family therapy.     

A narrative evaluation of a psychoeducation and a therapeutic alliance intervention for parents of persons with a severe mental illness

Most attempts to study the impact of psychosocial interventions on parents of persons with severe mental illness (SMI) are quantitative. The purpose of the present study was to investigate the subjective experience of parents of persons with SMI who participated in either a psychoeducational intervention which emphasized providing information on the illness and support, or a therapeutic alliance focused intervention (TAFI) which emphasized the alliance between the group members and group leaders. Ninety-three parents, who participated in either one of these two interventions, were interviewed using the Narrative Evaluation of Intervention Interview. Results show that participants found both interventions to be beneficial with no statistical differences in the level of perceived change. Themes describing change in relating to illness were significantly more frequently mentioned by participants in the TAFI group, whereas significantly more participants in the family psychoeducation interventions reported that implementation and information provided contributed to positive change. Also participants in the TAFI reported significantly more often that group regulation contributed to change. As both interventions were perceived as contributing, the findings support the relationship orientation to psychosocial interventions, which stresses the quality of the social support and interpersonal interaction as the source of positive outcomes of intervention.     

Intrafamilial sexual abuse: family-of-origin and family-of-procreation characteristics of female adult victims.

We examined connections between incest victims' family-of-origin and family-of-procreation characteristics in a sample of 40 American women who were in treatment for childhood or adolescent experiences of victimization. Retrospective data on their families-of-origin were collected along with their perceptions of current relationships with family members in the three-generational system. Results showed a close association between family-of-origin and family-of-procreation characteristics, especially in the areas of intergenerational intimacy, intergenerational fusion/individuation, and personal authority. A number of significant correlations were also found between subjects' past and present relationships with family-of-origin members and the dimensions of moral and religious orientation, achievement, and intellectual and cultural orientation, conflict, and control in their family-of-procreation. Some aspects of individual adjustment, including alienation, emotional discomfort, and defensiveness, were strongly related to various family-of-origin and family-of-procreation characteristics.     

Termination of Mental Health Services for Children

In this paper, we examine the termination of children's mental health services. Analyses were based on the 901 families in the Fort Bragg Evaluation Project who participated at Wave 1 and Wave 2 six months later. The project compared a full continuum of care provided at a demonstration site with traditional care at two comparison sites. The results showed that in most cases families and providers were partners in decisions to terminate treatment. About half of the clients self-terminated or were terminated solely at the discretion of the provider. Providers tended to play a more dominant role in terminating restrictive services; families played a more central role in terminating outpatient care. Regardless of initial psychopathology, children in single-headed households, whose parents were dissatisfied with services, did not expect their child to cooperate with treatment and did not expect treatment to help their child, were more likely to terminate care than others. While the Demonstration site had significantly fewer terminations, the sites did not differ with regard to the reasons for termination, who participated in termination decisions, or the factors that affected the likelihood to terminate care. Of most interest, mental health outcomes among children who had terminated all care did not vary by reasons for termination or by who participated in the termination decision.     

Context and culture in the socialization and development of personal achievement values: Comparing Latino immigrant families,European American families,and elementary school teachers

We documented cross-cultural similarities and differences in values concerning personal achievement between Latino immigrant parents, a group of multiethnic teachers, and European American parents. We also explored intergenerational similarities and differences between parents and their fifth-grade children. The theoretical premise was that sociodemographic factors, such as education, drive cultural values, with more formal education associated with individualistic values and less formal education associated with collectivistic/familistic values. Responding to open-ended social dilemmas relevant to family life, Latino immigrant parents, averaging a fifth-grade education, responded more familistically than the more highly educated multiethnic teachers or European American parents. In contrast, no group differences in values showed up in situations where school practices do not directly impact family life. Intergenerational differences were few; but, in family-centered scenarios, European American fifth graders were significantly more collectivistic than European American parents, a finding that suggested the possibility that, in an individualistic culture, individualism is socialized with age.     

Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families

Client engagement is an essential yet challenging ingredient in effective therapy. Engaged clients are more likely to bond with therapists and counselors, endorse treatment goals, participate to a greater degree, remain in treatment longer, and report higher levels of satisfaction. This study explored the process of engaging high-risk youth and their parents in a unique home-based family therapy intervention. Qualitative interviews were conducted with 19 families who completed family therapy sessions that included a core component aimed at increasing treatment engagement. Parents’ and youths’ perceptions of engagement suggest the importance of developing therapeutic alliance with therapists, who facilitated building a shared alliance among family members. Implications for improving client engagement are discussed within the context of alliance building with the therapist and among family members.     

Intergenerational continuity and discontinuity in Mexican-origin youths' participation in organized activities: insights from mixed-methods

Motivation theories suggest that parents are an integral support for adolescents' participation in organized activities. Despite the importance of parents, the field knows very little about how parents' own experiences in activities influence the participation of their adolescent children. The goals of this study were to examine (a) the patterns of intergenerational continuity and discontinuity in parents' activity participation during adolescence and their adolescents' activity participation, and (b) the processes underlying each of these patterns within Mexican-origin families. Qualitative and quantitative data were collected through three in-depth interviews conducted with 31 seventh-grade adolescents and their parents at three time points over a year. The quantitative data suggested there was modest intergenerational continuity in activity participation. There were three distinct patterns: nine families were continuous participants, seven families were continuous nonparticipants, and 15 families were discontinuous, where the parent did not participate but the youth did participate in activities. The continuous participant families included families in which parents valued how organized activities contributed to their own lives and actively encouraged their adolescents' participation. The continuous nonparticipant families reported less knowledge and experience with activities along with numerous barriers to participation. There were three central reasons for the change in the discontinuous families. For a third of these families, parents felt strongly about providing a different childhood for their adolescents than what they experienced. The intergenerational discontinuity in participation was also likely to be sparked by someone else in the family or an external influence (i.e., friends, schools).     

Theory of Change Projects in MFT Programs

Taibbi (1996) suggests that therapists who have clear ideas of their personal models of therapy will be better therapists. This study attempted to learn more about how marriage and family therapy (MFT) programs use theory of change projects to assist students' development of their personal models. Questionnaires were sent to MFT master's, doctoral, and post-degree programs accredited by the Commission on Accreditation for Marriage and Family Therapy. Nearly 60% of responding programs indicated that they do include theory of change projects in their programs. Data were analyzed for similarities and differences in both the contents and processes of the projects.     

Family Stress and Adjustment as Perceived by Parents of Children with Autism or Down Syndrome: Implications for Intervention

ABSTRACT

This study examined stress and adjustment in parents of three groups of families: those with an autistic child, those with a Down syndrome child, and those with only developmentally normal children. A total of 54 families participated, with 18 representing each group. Parents of autistic children generally reported more family stress and adjustment problems than parents of children with Down Syndrome who, in turn, reported more stress and adjustment problems than parents of developmentally normal children. Although parents of disabled children reported more stress associated with caring for their child, they generally showed resilience in adjusting to the presence of a severely disabled family member. Implications for family intervention are discussed.     

Skills training in the long-term management of stress and occupational burnout

The current managed healthcare environment stresses brief and effective short-term therapy. However, often this short-term treatment does not lead to long-term behavioral changes and clients return to therapy many times for help with the same dysfunctional behavioral patterns. The main problem with these traditional forms of treatment is the assumption that clients have the basic skills to change their ineffective behaviors. Yet, many people lack the basic skills to manage our highly stressful society, and may take years to master new behavioral management skills. Examining the relationship between stress and coping, this study explored both short-and long-term approaches to behavioral change relative to occupational burnout, and focused upon the teaching of skills to manage stress. Subjects who participated in a 6-week stressmanagement program reported only temporary decreases in burnout, while those subjects who received 1-hour coping “refresher” sessions at 5 months, 11 months, and 17 months showed consistent decreases in burnout throughout a 2 1/2 year period. These results suggest that psychologists can be much more effective behavioral change agents through long-term approaches that emphasize teaching new skills to manage chronic behavioral problems. Given the changes in the health insurance industry and the way therapeutic services are provided, the field may need to rethink approaches that are grounded in personality theory and abnormal psychology to approaches that emphasize principles of learning theory.