The relevance of current clinical practice in child psychotherapy to child psychiatry

SUMMARY

The role of child psychiatrists is evolving. Economic and psychosocial factors such as marital breakdown, inner city decline, unemployment, plus increased awareness of conditions such as Substance Abuse and all forms of Child Abuse have led to stress for children and their caretakers. There is also increasing recognition that with help many troubled children and their families can emerge better able to function. Child psychiatrists occupy a pivotal position in the child mental health team and need to be familiar with all the treatment options available to ensure their effective use. This paper presents examples of current work being undertaken by child psychotherapists and discusses the implications of this for the training of child psychiatrists as well as for clinical work.     

Approaching the religious patient in forensic psychiatry,with special focus on ethnic minority patients

ABSTRACT

Ethnic minority patients are overrepresented in Danish forensic psychiatry and knowledge is needed on how these patients are approached in relation to religious and cultural issues. The aim of this study was to investigate how psychiatrists in Danish forensic psychiatry approach religious ethnic minority patients. The study revealed positive approach towards religious ethnic minority patients. However, unless religion features as part of the illness, the tendency is to not incorporate the patients’ religiosity in treatment. The study finds that the hospital chaplain is regarded by the psychiatrists as an important part of the ward and expressed the desire for a more formal cooperation with religious specialists to be developed. Finally, the study finds that religious practices such as Ramadan, common prayer, and Islamic edicts on food and unlawful touch are areas where more knowledge is needed, especially in relation to anxiety, potential stress, and conflict situations.     

Couple and Family Therapy Within the Current Pan-Canadian Context

Canadians take numerous approaches to couple and family therapy due in part to Canada’s diversity of people and geography, as well as the influence of the health care context, a central facet of our national identity. Tracing back to Nathan Epstein, the founder of family therapy in Canada, there continues to be a strong tradition of couple and family therapy within Canada which has international reach. Formal training in family therapy, as well as couple/marital therapy occurs largely outside of the scope of degree granting programs and university settings. The American Association for Marriage and Family Therapy has a strong presence in Canada, with six divisions across the country. Popular models of practice for Canada’s couple and family therapists include cognitive-behavioral therapy, solution-focused therapy, narrative therapy, emotionally-focused therapy, and Bowenian/intergenerational therapy. A growing number of training opportunities are becoming available across Canada, and the practice of couple and family therapy is becoming institutionalized as one of the core competencies for professions such as psychiatry. In this article, we examine the context of family therapy in Canada by examining its history, the unique accreditation standards, qualifications and organizations associated with family therapy, the relationship between couple and family therapy, and future directions for this field of practice.     

Training analysis in the dutch society for psychoanalytic psychotherapy: A survey of attitudes and feasibility

SUMMARY

As is the case in many training courses in psychoanalytic psychotherapy, one of the training requirements of the Dutch Society for Psychoanalytical Psychotherapy (NVPP) is a training analysis, currently a minimum duration of 700 hours. During the last few years, this requirement has become somewhat controversial. Because the NVPP does not have information about the current interest in NVPP membership, the Board of the NVPP decided to do a survey. Of 995 psychiatrists, clinical psychologists and psychotherapists, who had recently completed their training, or were still in training, 623 filled in a questionnaire. Of those who are interested in the NVPP training, 39 per cent judged the training analysis as not feasible in terms of time, and 61 per cent in terms of money. Forms of personal treatment thought desirable for anyone who wishes to become a psychoanalytic psychotherapist at a specialist level are, in descending order, psychoanalytic psychotherapy (63%), psychoanalysis (39%), psychoanalytic group psychotherapy (25%), and psychoanalytic marital or family therapy (6%). Respondents who judge personal analysis as not feasible, also tend to judge psychoanalysis to be equivalent to other forms of psychoanalytic psychotherapy, whereas those who judge personal analysis as feasible, tend to think that personal analysis is essential for a psychoanalytic psychotherapist at the specialist level.     

Integrating Family Therapy Training into Psychiatry Residency Programs: Policy Issues and Alternatives

This article explicates policy issues and alternatives in the integration of family therapy training within general psychiatry residency programs. These issues include controversies about the definition of the field; elective versus required teaching; curriculum content; and when, where, and who should teach family therapy in this context. The article concludes with recommendation for further clarification of this training area.     

Family Therapy Training in Selected General Psychiatry Residency Programs

This paper describes the current state of family therapy training in general psychiatry residency programs (GPRP) in the United States. Based on a national survey of 80 GPRP training directors, current practices and attitudes toward family therapy training are assessed. The principal finding is that there has been a significant increase in the amount of required family therapy training in GPRP over previous years and many of the programs would like to expand their current curriculum. Issues concerning course content, definition of family therapy employed, and the meshing of different theoretical paradigms are considered. Recommendations for further research and for the initiation of intradisciplinary and interdisciplinary dialogue are presented.     

Prospective associations from family-of-origin interactions to adult marital interactions and relationship adjustment.

To test the social learning-based hypothesis that marital conflict resolution patterns are learned in the family of origin, longitudinal, observational data were used to assess prospective associations between family conflict interaction patterns during adolescence and offspring's later marital conflict interaction patterns. At age 14 years, 47 participants completed an observed family conflict resolution task with their parents. In a subsequent assessment 17 years later, the participants completed measures of marital adjustment and an observed marital conflict interaction task with their spouse. As predicted, levels of hostility and positive engagement expressed by parents and adolescents during family interactions were prospectively linked with levels of hostility and positive engagement expressed by offspring and their spouses during marital interactions. Family-of-origin hostility was a particularly robust predictor of marital interaction behaviors; it predicted later marital hostility and negatively predicted positive engagement, controlling for psychopathology and family-of-origin positive engagement. For men, family-of-origin hostility also predicted poorer marital adjustment, an effect that was mediated through hostility in marital interactions. These findings suggest a long-lasting influence of family communication patterns, particularly hostility, on offspring's intimate communication and relationship functioning.     

Family Therapy Training: The Institutional Base

The papers that follow present the findings of three surveys of the institutional base for training in family therapy. ¹ 1 Names and addresses of all facilities known to provide education in this field as of 1980 are available at a charge of U.S. $10.00; checks are to be made out to Family Process.
The surveys were initiated and conducted independently. To some extent they overlap. This is particularly true of the Bloch and Weiss effort in that it does not limit itself to a sector of the training process bounded by a single discipline, as do the other two papers. Despite some overlap, each paper stands independently; of particular interest are the varied analyses and special emphases each provides. We hope that their publication will stimulate similar studies in the years to come, so that family therapy can take advantage of the observation of its own growth and development. We are accustomed to including ourselves in the field of observation, so far as the family system is concerned; it seems reasonable to extend these perspectives to the more macroscopic field of the institutional development of family therapy. Of particular importance to us, and I believe to science generally, is the opportunity to observe a paradigmatic shift taking place with the development of this new field and the adoption of its associated epistemology by the senior professions of social work, psychology, and psychiatry. Family systems theory and practice have implications that extend beyond their own borders; they can make a significant contribution to the systems revolution that is taking place in science generally. These studies should be of use to practitioners, teachers, and students alike. It seems to me that their implications are clear: that training in family therapy at a sophisticated level is now to be a regular part of the future training of psychiatrists (possibly all physicians), psychologists, social workers, and psychiatric nurses and that, in addition, as a second distinctive career line, there is the new profession of family therapist, with its own entry point and academic pathway. My view is that society will support both lines of career development as far into the future as one can reasonably hope to see. The only logical ending to this will be a shift in the medical model from its present linear definitions of illness and treatment to an ecosystemic, biopsychosocial definition. These describe a historical crosssection through that process.     

An experientially based inductive approach to learning about family therapy

Abstract

The numerous and diverse approaches to the practice of family therapy pose a critical dilemma to practicing family therapists confronted with selecting a direction of study to further enhance their own professional knowledge and skill bases. This paper describes and evaluates a five-phase training model which facilitates practitioners' choices in regard to model selection by providing them with an opportunity to compare their own therapeutic belief and action systems with those of family therapists oriented to one of three historically prominent models of family therapy.     

Domestic Violence

Summary

In this paper, the authors outline their experience in incorporating a curriculum on domestic violence into an urban family practice residency program. Based on the concept that in order to successfully develop such a curriculum, it is necessary to address the “culture of the organization,” joint educational strategies that in-elude resident education as well as faculty development were considered. A research question was designed to inquire as to the difference in the level of knowledge about domestic violence in family practice faculty as compared to residents prior to the introduction of educational strategies. The authors describe curriculum goals and objectives and outline specific teaching methods as well as the evaluation instrument utilized in the study to measure actual difference in knowledge between faculty and residents about domestic violence with a focus specifically on spousal abuse. Their conclusions point to the need for an educational strategy that includes emphasis on the faculty-resident interface which utilizes both traditional and non-traditional integrated formats in order to successfully train residents in the identification and treatment of domestic violence.     

Controversies and Conflicts in the Institution of "Open" Psychoanalysis: Cases from the History of the Therapeia Foundation

The institution of psychoanalysis has included controversies, dissensions and expulsions at both the theoretical-methodological and personal-organizational levels. There have also been several intra- and intergroup conflicts in the history of psychoanalysis, and in constructing and patterning the future of psychoanalytic knowledge. In the context of Finnish psychoanalysis, the Therapeia Foundation (founded in 1958) met from the start with resistance from official psychiatry and also from the IPA. For example, in the mid-1960s, D. W. Winnicott, as the President of the IPA, supported the orthodox Finnish psychoanalytic study group (later to become the Finnish Psychoanalytical Society), and pronounced that the Therapeia group was too loose and was not strictly able to use the IPA-recognized designation "psychoanalytic." The Therapeia Foundation and its Training Seminar combined classical psychoanalysis and its new versions with existentialphenomenological views, anthropological medicine, research on "social pathology" and even modern theological research. On the basis of their Swiss analytic training, three Finnish psychiatrists, Martti Siirala, Kauko Kaila and Allan Johansson, organized Therapeian training to incorporate sciences and arts, and skills involving the therapeutic "carrying" of burdens. The multifacted nature of open psychoanalysis was seen to find its proper organizational expression when the Training Seminar of the Therapeia Foundation became, in 1974, a Member of the IFPS.     

The Effectiveness of Attachment Injury Resolution Model (AIRM) on Increasing Trust among the Injured Women with Marital Infidelity: A Case Study Approach

Abstract

Objective: The present study aimed at determining the effectiveness of emotionally-focused couple therapy, based on attachment injury resolution model (AIRM) on increasing trust among the injured women with marital infidelity. Method: The present study was a single case experiment of the multiple baseline design type. The population included all injured women with marital infidelity, referring to Bushehr family therapy clinics, among whom three women were selected and participated in the intervention through purposive sampling method, based on the desired recall, By considering the inclusion and exclusion criteria and answering the trust scale. Data analysis was conducted by visual analysis, clinically meaningful (reliable change index and normative comparison) and percentage improvement formula. Results: The percentage obtained from the overall increase of trust among the injured women during the therapy was 38.76 and follow-up was 48.58. In addition, the reliable change index during the therapy and a follow-up was 2.77 and 3.49 in the first couple, 3.10 and 3.62 in the second couple, 2.66 and 3.67 in the third couple indicating that these values were significant and higher than z?=?1.96 during the therapy and follow-up (p?=?0.05). Conclusion: Based on the research results, the emotionally-focused couple therapy based on attachment injury resolution model can be used as an effective intervention in reducing the injuries by marital infidelity.     

Marital intimacy,family support,and secondary traumatization: A study of wives of veterans with combat stress reaction

Abstract

The main aim of the study was to assess the role of family variables in the process of secondary traumatization among wives of post-traumatic veterans. We compared a sample of 49 wives of Israeli veterans with combat stress reaction (CSR) from the 1982 Lebanon War with a sample of 31 wives of Israeli veterans who fought in the war without developing CSR. We assessed their psychological reactions to the war, their health status six years later, and their reported levels of marital intimacy and family support after the war. When compared with controls, wives of veterans with CSR reported more negative emotions and lower perceived intimacy after the war, and greater severity of psychiatric and somatic symptoms six years later. Results also indicate that the greater the perceived marital intimacy, the less the negative emotions wives of veterans with CSR felt after the war and the better their health status six years later. In addition, wives of veterans with CSR who reported having received more support from their families after the war reported more anxiety and hostility than wives who received less support. The roles of marital intimacy and family support in the process of secondary traumatization were discussed.     

Comparison of reciprocity and discussion-type counseling for marital problems

Abstract

Reciprocity counseling had previously been found to increase reported marital happiness in a study using a within-subject design. Fifty-five couples served in the present study using a between-subjects design, additional response measures, and additional positive communication training. The reciprocity counseling provided behavioral contracting, communication training and instruction in mutual reinforcement, whereas the control procedure encouraged discussion of the problems. The reciprocity counseling produced significantly more improvement than the discussion-type counseling for the three marital adjustment measures after four sessions. The improvement was maintained during the 24 months of follow-up.     

Sources of influence on the professional development of psychologists and psychiatrists in Norway and Germany

Background: There are many professional psychotherapists, but no psychotherapy profession. The psychotherapists’ professions vary between countries, the most frequent being psychiatry and clinical psychology.

Aim: As these professions have different basic training and also may be impacted differently by other factors, we wanted to study potential differences as to perceived influences on their development as psychotherapists across career level, theoretical orientation, and gender.

Methods: More than 2500 Norwegian and German psychiatrists and psychologists reported data on their professional development in the DPCCQ/2000, a lengthy multi-part survey instrument developed within the ‘Collaborative Research Network’ of the Society for Psychotherapy Research. The four groups were compared for differences, and a series of multiple regression analyses were conducted to examine the impact of profession on a variety of aspects of therapist experiences.

Results: Although a few therapist experiences (e.g. teaching, treating patients, institutional conditions) had a significantly different impact between the two professions, as a main effect, they only accounted for less than 1% or the variance.

Conclusion: Profession seems to have little influence on perceived development as a psychotherapist, and it is reasonable to conclude that other therapist qualities, often personal qualities, are more important for therapeutic processes and outcomes.     

Evaluating Training Needs for Home-Based Family Therapy: A Focus Group Approach

Therapists and supervisors engaged in the delivery of home-based services participated in two rounds of focus groups. Participants discussed the challenges they face doing home-based therapy, and how an accredited family therapy program could modify its curriculum to better prepare trainees to meet these demands. Eight topic areas considered necessary for home-based practice were identified and the implications for training reviewed. The focus group methodology is described in detail and is recommended as a useful tool to assess training needs and as a way of promoting improved collaboration among training sites.     

Systemic Reflecting Team Training: Perceptions and Experiences of South African Educational Psychologists

Abstract

There is limited research on the application of systemic family therapy in developing countries. This qualitative study explored the perceptions and experiences of 12 educational psychologists and a family therapy trainer, who have worked within a systemic reflecting team using Tom Andersen’s method of training and supervision. The semi-structured interview findings suggested positive perceptions of systemic intervention, despite various challenges experienced in its implementation within the South African context. The educational psychologists identified their reflecting team experiences as being beneficial for both their professional development and current practices. Future research which investigates the reflecting team process in action is recommended.     

Daily Hassles,Intimacy, and Marital Quality in Later Life Marriages

This study addressed the relationship between daily stress, intimacy, and marital quality in mature marriages in which the ages of husbands and wives ranged from 55 to 75 years. Four hundred and seventy-two individuals married to each other and randomly sampled from all fifty states completed the Kansas Marital Satisfaction Scale, the Personal Assessment of Intimacy in Relationships, and the Hassles and Uplifts Scale. Findings indicated that daily stress was negatively related to marital quality for both wives and husbands, and that intimacy mediated the relationship between stress and marital quality for both husbands and wives. Implications for marriage and family therapy practice are explored.     

Training psychiatric teams to do family systems acute psychiatry

This article presents an account of a comprehensive eighteen‐day, multi‐team, multidisciplinary training approach to family systems inpatient acute psychiatry. It has been developed and tested as part of the SYMPA project (systems therapy in acute psychiatry), which aims to establish systemic case conceptualizations and interventions as routine practice in acute psychiatry. Content, didactic characteristics and specifications of this training are discussed. To illustrate the practical implementation of the training, specifically designed exercises are described and a clinical case is included. The article concludes by presenting first results of the research on implementation indicating that the training had a significant impact on the quantity and quality of conversations with patients.