Issues in the Assessment of Outcome in Family Therapy

This paper examines several issues in family therapy outcome research. These include the need to consider numerous population and treatment variables, the influence of treatment goals and values upon the research, the difficulties in defining and operationalizing family treatment, the choice between emphasizing integrity of treatment or randomness of sampling, the selection of measurement methods, the controls needed in research design, the extent of generalizability of results, the importance of efficiency of treatment, and the special role of deterioration effects. Throughout, the need for a multivariate schema for conceptualizing this research and special attention to the role of values and assumptions in it are highlighted.     

Why a family perspective for pain?

Although it is well established that families have a strong influence on individuals' beliefs and behaviors related to health and illness, relatively little attention has been devoted to the family's role in the development, maintenance, and treatment of pain or to the impact of chronic pain in one family member upon other family members. A major source of information about pain and how to respond to pain symptoms is learned within the family setting. This article reviews ways in which pain conceptualizations are developed in the family and highlights the need to more carefully study health as well as dysfunctional family reactions to chronic pain. A case example is presented that details the far reaching consequences that chronic pain can have on family life. It is concluded that more careful research, particularly in terms of the operationalization of theoretical constructs and the reliable assessment of these constructs, is needed before any definitive statements can be made about the importance and characteristics of pain-family transactions.     

Family therapy as a treatment for children: a critical review of outcome research.

The value of family therapy as a treatment for child psychopathology is considered by reviewing pertinent outcome research. Fourteen studies that met three criteria are included in the review: (a) a child or adolescent was the identified patient or referral; (b) therapy included at least one parent and the child; and (c) outcome was evaluated in terms of the child's symptoms. There are major shortcomings in most of the available data, with only two well-controlled studies. Some empirical evidence does exist that family therapy is an effective treatment for children; the data from studies of adolescents are especially encouraging. However, insufficient data are available for comparing the relative merits of conjoint family treatment and individual child therapy. If the value of family therapy as a treatment alternative or, ideally, as the "treatment of choice" for a referred individual child is to be established, more and better controlled comparative outcome studies will be necessary. Suggestions for future research are presented emphasizing the need for a developmental perspective by recommending, for example, the use of factorial designs in which the intervenaction of treatment and age can be analyzed.     

Couple and Family Treatments: Study Quality and Level of Evidence

This paper examines the application of the guidelines for evidence‐based treatments in family therapy developed by Sexton and collaborators to a set of treatment models. These guidelines classify the models using criteria that take into account the distinctive features of couple and family treatments. A two‐step approach was taken: (1) The quality of each of the studies supporting the treatment models was assessed according to a list of ad hoc core criteria; (2) the level of evidence of each treatment model was determined using the guidelines. To reflect the stages of empirical validation present in the literature, nine models were selected: three models each with high, moderate, and low levels of empirical validation, determined by the number of randomized clinical trials (RCTs). The quality ratings highlighted the strengths and limitations of each of the studies that provided evidence backing the treatment models. The classification by level of evidence indicated that four of the models were level III, “evidence‐based” treatments; one was a level II, “evidence‐informed treatment with promising preliminary evidence‐based results”; and four were level I, “evidence‐informed” treatments. Using the guidelines helped identify treatments that are solid in terms of not only the number of RCTs but also the quality of the evidence supporting the efficacy of a given treatment. From a research perspective, this analysis highlighted areas to be addressed before some models can move up to a higher level of evidence. From a clinical perspective, the guidelines can help identify the models whose studies have produced clinically relevant results.     

Play therapy as a family restructuring technique: A case illustration

This paper presents a general treatment approach which uses play to integrate individual and family psychotherapy when working with young children as identified patients. Play therapy techniques are explored with regard to their potential impact upon a family system. Perspectives on concurrent and conjoint family oriented treatment using play are discussed with a focus upon achieving both individual and family system growth.     

Culturally sensitive therapy? Examining the practice of cross‐cultural family therapy

This article is drawn from a research project that examines cross‐cultural family therapy sessions in order to consider what constitutes culturally sensitive practice. A discourse analytic approach was adopted in the analysis of three sessions from two families where the family and the therapists originated from different ethnic backgrounds. This article is based around part of the research findings connected to one of the families, and focuses upon the ways in which ‘culture’ is talked about in therapy (the term ‘culture’ will be referred to in inverted commas in order to acknowledge its complexity as is emphasized in this article). This allows for an examination of the cultural assumptions that we hold as therapists, which are enacted in therapy with effects on all participants and upon the course of the therapy. The value of qualitative research methods in examining the cultural assumptions we bring to therapy is highlighted as one way of improving culturally sensitive therapeutic practice, especially with regard to therapist reflexivity.     

Truth and beauty in scientific reason

A rationalist and realist model of scientific revolutions will be constructed by reference to two categories of criteria of theory-evaluation, denominated indicators of truth and of beauty. Whereas indicators of truth are formulateda priori and thus unite science in the pursuit of verisimilitude, aesthetic criteria are inductive constructs which lag behind the progression of theories in truthlikeness. Revolutions occur when the evaluative divergence between the two categories of criteria proves too wide to be recomposed or overlooked. This model of revolutions depends upon a substantial new treatment of aesthetic criteria in science with which much of the paper will therefore be occupied.     

Family therapy in treatment of the deaf: a case report.

Deaf patients with psychological problems have developmental handicaps and clinical characteristics that reduce the effectiveness of traditional modes of psychotherapy. Attempts have been made to utilize individual and group therapy, but family therapy has been largely overlooked as a method of alleviating problems of the deaf. Clinical and research writings provide us with rich insights into the family dynamics of the deaf. These data suggest to the authors that the problems of deaf individuals are largely related to family problems, and therefore merit a family orientation as the focus for treatment. This paper describes an attempt to apply family therapy with a range of deaf patients over a period of two years. From a review of their work, the authors conclude that family therapy can be effective, particularly in the treatment of deaf adolescents and children.     

Case Report: Smuggling Family Therapy Through

Therapists with a family systems orientation are, on occasion, called upon to work in settings where political constraint, cultural patterns or the unchangeable expectations of the clinical population make it impossible to identify the treatment as being directed at the family. Under these circumstances, family therapy concepts and techniques may be employed by smuggling them in under another label. This article describes a setting in which such a strategy was necessary.     

Introducing Novice Therapists to “Go-Between” Techniques of Family Therapy

The training of family therapists requires that learning objectives and expectations be specified in empirical terms so that the trainer and trainee can achieve clear goals, identify areas of progress, and meet the special needs of the trainee. This paper articulates the competencies, objectives, and criteria for evaluation used during a time-limited training program for therapists involved in family therapy research conducted at Centennial School of Lehigh University.     

Involving Family in Psychosocial Interventions for Chronic Illness

ABSTRACT— Interactions with close family members have consequences for the emotional and physical well-being of individuals who are dealing with a chronic physical illness. Therefore, inclusion of a close family member in psychosocial interventions for chronic illnesses is a logical treatment approach that has the potential to boost the effects of intervention on the patient and also benefit the family member. However, randomized, controlled studies indicate that such family-oriented interventions generally have small effects. The efficacy of these treatment approaches might be enhanced by targeting specific interactions that emerging research identifies as promoting or derailing healthy behaviors and by better incorporating strategies from family caregiver interventions. In addition, family-oriented interventions should be more fully evaluated, by assessing the benefits for both patients and family members. Future research in this area can tell us much about how and when to involve family in treatment of specific chronic illnesses and, in turn, may inform conceptual models of the impact of family interactions on health.     

A Critical Methodological Review of Discourse and Conversation Analysis Studies of Family Therapy

Discourse (DA) and conversation (CA) analysis, two qualitative research methods, have been recently suggested as potentially promising for the study of family therapy due to common epistemological adherences and their potential for an in situ study of therapeutic dialog. However, to date, there is no systematic methodological review of the few existing DA and CA studies of family therapy. This study aims at addressing this lack by critically reviewing published DA and CA studies of family therapy on methodological grounds. Twenty‐eight articles in total are reviewed in relation to certain methodological axes identified in the relevant literature. These include choice of method, framing of research question(s), data/sampling, type of analysis, epistemological perspective, content/type of knowledge claims, and attendance to criteria for good quality practice. It is argued that the reviewed studies show “glimpses” of the methods’ potential for family therapy research despite the identification of certain “shortcomings” regarding their methodological rigor. These include unclearly framed research questions and the predominance of case study designs. They also include inconsistencies between choice of method, stated or unstated epistemological orientations and knowledge claims, and limited attendance to criteria for good quality practice. In conclusion, it is argued that DA and CA can add to the existing quantitative and qualitative methods for family therapy research. They can both offer unique ways for a detailed study of the actual therapeutic dialog, provided that future attempts strive for a methodologically rigorous practice and against their uncritical deployment.     

Evidence-based psychological treatments for distress in family caregivers of older adults

This review identifies evidence-based psychological treatments (EBTs) for reducing distress, and improving well-being, of family members caring for an older relative with significant cognitive and/or physical impairment. Three categories of psychologically derived treatments met EBT criteria: psychoeducational programs (N = 14 studies), psychotherapy (N = 3 studies), and multicomponent interventions (N = 2 studies). Specifically, support within the psychoeducational category was found for skill-training programs focused on behavior management, depression management, and anger management and for the progressively lowered threshold model. Within the psychotherapy category, cognitive-behavioral therapy enjoys strong empirical support. Within the multicomponent category, programs using a combination of at least 2 distinct theoretical approaches (e.g., individual counseling and support group attendance) were also found to be effective. Suggestions for future research include the development of more well-integrated multicomponent approaches, greater inclusion of ethnically diverse family caregivers in research protocols, and greater incorporation of new technologies for treatment delivery.     

Quartic rotation criteria and algorithms

Most of the currently used analytic rotation criteria for simple structure in factor analysis are summarized and identified as members of a general symmetric family of quartic criteria. A unified development of algorithms for orthogonal and direct oblique rotation using arbitrary criteria from this family is given. These algorithms represent fairly straightforward extensions of present methodology, and appear to be the best methods currently available.The research done by R. I. Jennrich was supported by NSF Grant MCS-8301587.     

Family measurement techniques: The family health scales (fhs): Review and critique

Abstract

Kinston, Loader and Miller (1987) have developed the Family Health Scale (FHS), a research instrument designed to assess a family's level of overall functioning based upon the clinical observation of family interaction. The authors state that the FHS is primarily a research tool, allowing its users to test hypotheses about family dysfunction, to examine changes in the family longitudinally, and to categorize families by “degree of disturbance.” While not its principal use, the scale is also thought to have teaching utility.     

Focused videotape feedback psychotherapy: An integrated treatment for emotionally and behaviorally disturbed children

This controlled study describes the development and therapeutic effectiveness of Focused Videotape Feedback Psychotherapy. FVFP integrates parent-training, family therapy, and psychodynamically-oriented therapy as a treatment for children with emotional and behavioral disorders. Of the 105 children and their families, ages 4-10 years, referred for the study, only 40 met the strict diagnostic, research, and randomisation criteria for inclusion in one of the three research groups: FVFP, Psychodynamically-oriented, or Control. Evaluation was at pretreatment, 8 weeks, 16 weeks, and 20th week follow-up. Both treatment procedures were effective. FVFP produced more positive behavioral and affective changes at follow-up and was more time and cost effective.     

Family psychoeducation as an evidence-based practice

Family psychoeducation programs have emerged as a strongly supported evidence-based practice in the treatment of schizophrenia and bipolar disorder. Over 30 randomized clinical trials demonstrated that psychoeducation programs reduce relapse, improve symptomatic recovery, and enhance psychosocial and family outcomes. Recent work supports family psychoeducation strategies for other disorders, including major depression, obsessive-compulsive disorder, and borderline personality disorder. This review summarizes the research evidence supporting prominent models of family psychoeducation. Professional and peer-led family education programs are also reviewed and differentiated from family psychoeducation. Directions for future research studies to enhance the evidence base and inform treatment recommendations are proposed. Finally, strategies for implementation of family psychoeducation in routine clinical practice are discussed.     

Families and the Origins of Child Behavior Problems

This article reviews recent research into the relationship between family variables and child behavior. Although a diversity of factors may be associated with the development and maintenance of conduct/oppositional disorders in children, of primary importance are the moment-to-moment interactions that the child has with his or her primary caregivers. These are often marked by coercive, aggressive behaviors that may be functional for parents and children within the family system. However, the likelihood that parents will engage in coercive interactions with the child is also related to the latter's personal adjustment, which, in turn, is often dependent upon the parents' perceptions of the quality of marital and social support available to them. The goal for clinicians working with families of oppositional/conduct-disordered children is to retain the demonstrated efficacy of direct intervention into parent-child interactions while developing methods of assessment and treatment that attend to broader family variables, for example, marital disorder, interfering in-laws, and social isolation that may be functionally related to the occurrence of coercive parent-child interactions.     

Self-injury behavior, economic status and the family anomie syndrome among adolescents.

Only recently has there been a focus upon the psychosocial environment of the family that surrounds the suicide-prone individual. The purpose of this research was to learn more about the association of economic status and family anomie, operationationalized by family normlessness and powerlessness scales, to the differential vulnerability of adolescents to suicide potential. The research design called for a detailed interview with the persons attempting suicide and members of their families. The study samples consisted of 30 low economic and 25 high economic status families. It was predicted that social anomie could be translated into behavioral (attempted suicide) and attitudinal (normlessness and powerlessness) determinants when viewed with regard to its impact upon the family. Significant differences in the degree of normlessness and powerlessness were found for suicidal and nonsuicidal adolescents and their families. These differences appear to be part of a family anomie syndrome.