Integrating Internal Family Systems and Solutions Focused Brief Therapy to Treat Survivors of Sexual Trauma

In a recent study 56% of women and 37% of men were survivors of childhood sexual abuse. These individuals who experience sexual trauma may experience depression, anxiety, post-traumatic stress disorder (PTSD) or substance use disorders (Devlin et al., in Fam J 27(4):359–365, 2019). While there are several treatment approaches specifically developed to target trauma and its effects, (e.g., trauma focused cognitive behavioral therapy, and eye movement desensitization and reprocessing) we propose that integrating internal family systems therapy (IFS) and solution focused brief therapy (SFBT) offers a brief, systemic way to improve family relationship patterns in families where one member has experienced sexual trauma. A case vignette is used to show the integration of these two approaches.

     

Bridging the Divide Between Psychodynamic and Behavioral Approaches for Children with Oppositional Defiant Disorder

ABSTRACT

Oppositional defiant disorder (ODD) is one of the primary reasons youth are referred to mental health services. Disruptive behavior disorders such as ODD are heterogeneous in their presentation, developmental trajectories, and treatment needs. Given the high attrition rates in child psychotherapy in general, there is a need for a range of interventions tailored to meet the unique needs of each family to help increase familial engagement and positive outcomes for children with ODD.

This article outlines composite clinical case material of a child with ODD who was treated with Regulation Focused Psychotherapy for Children (RFP-C), a manualized, psychodynamic intervention for ODD. The case presented is then reconceptualized from a behavioral parent training perspective. This approach uses parent training to encourage positive parenting practices and reduce coercive reinforcement cycles. The case material and its reconceptualization are followed by a discussion of the distinctions between psychodynamic and behavioral approaches to children with ODD. An integrated psychotherapy approach is proposed, and the benefits and challenges of psychotherapy integration are discussed.     

The interface of family disturbance and individual patienthood

Abstract

This paper addresses the need to approach understanding the individual patient's psychopathology from the vantage point of two etiologic systems: psychoanalytic object relations theory and family systems theory. The complementarity of these approaches is emphasized. It is suggested that the processes of internalization and projection are bridging concepts and that marital relationships provide a unique research context.     

Family-focused management: Treatment of choice for deviant and dependent families

Abstract

Helping professionals working with troubled families takes two approaches. One approach, noting that the identified patient's family's behavioral interactions have positive and negative effects on the patient and his symptoms, advocates involving family members in the treatment process. The other approach, noting that the identified patient alone has the power to resolve his problem, advocates treating the patient independently of the family. This latter approach, in effect, relieves family members of the painful feelings of responsibility. At first glance, these two approaches appear to be in conflict, and it is no wonder that professionals choose to remain with one or the other. Both points of view are valid, so that approaches need to be developed which incorporate both.     

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.     

Integrating Individual and Family Systems Psychotherapy to Treat Borderline Personality Disorder

This paper focuses on two areas. The first is the framework for psychotherapy integration used by Unified Therapy, a psychotherapy approach that is an integration of psychodynamic, cognitive–behavioral, and family systems therapy. The second is the use of this treatment paradigm in the psychotherapy of adults with borderline personality disorder. The theory posits that continuing and recurrent interpersonal behavior patterns within the patient's family of origin serve as behavioral triggers to typical acting-out behaviors. Therapy is geared toward planning strategies to alter these destructive patterns. A case example is presented to demonstrate the use of the therapy's theories and techniques.     

A Supervision Approach for Teaching Structural/Strategic Therapy in a Limited Setting

Many counselors are currently undergoing a Kuhnian paradigm shift from linear models of behavioral problem conceptualization to systemic conceptual models. As a result, it has become incumbent on counselor-educators to introduce the systems concept of family therapy to their students within a framework that renders it meaningful not only intellectually but also practically. This paper presents one way of doing this successfully with master's level counselors-in-training who have no live families on which to practice. An overview of systems approaches to family therapy is presented along with a seven-stage supervision approach for teaching structural/strategic therapy in limited situations where the supervision of live families is not practical or possible.     

COVID-19 pandemic impact on family life and exacerbated emotional and behavioral health among preschool children: A longitudinal study

Background/ObjectiveThis study aimed to examine associations of the impact of COVID-19 pandemic on family life with emotional and behavioral health among preschool children.MethodsA longitudinal study including 1595 preschool children aged 3–6 years and their families was conducted in Anhui Province. The linear regression was applied to examine associations between the impact of COVID-19 pandemic on family life and emotional and behavioral health.ResultsResults of the multivariable linear regression indicated that the severe impact of COVID-19 pandemic on family life was significantly associated with more sleep problems, poor dietary behavior habits, more anxiety symptoms, and more problematic behaviors; and these effects exhibited gender and age differences.ConclusionsThe severe impact of COVID-19 pandemic on family life significantly increased the risk for exacerbated emotional and behavioral health among preschool children. It is considered vital to identify risk factors for vulnerable families and then to implement precise interventions when necessary for emotional and behavioral health of children in these families.     

Exploring the Use of an Integrative and Ecological Framework When Treating Children with Trauma

ABSTRACT

Children’s clinical symptoms can often only be understood within their individual and family contexts. However, contemporary research has pointed to the importance of also working with children’s social identities and macrosystem environment when attempting to understand and treat clinical problems. The case of a 10-year-old Dominican-American girl who presented with a significant trauma history, oppositional behavior, and difficulties interacting with her peers is examined using a developmental ecological framework. Attachment theory, cognitive behavioral therapy, narrative therapy, and multicultural family systems therapy, with a focus on trauma responses, are integrated when exploring the case. Additionally, the benefits of exploring the influence of social identities (race, ethnicity, immigration status/perceived immigration status, and class) are explored via an approach that focus on transformation and healing from oppressive systems by integrating sociopolitical realities in therapy.     

Elective mutism in children: A family systems approach

Abstract

Elective mutism in children is a relatively rare symptom which is more prevalent in the kindergarten population and has a higher incidence among immigrant families. Treatment strategies for this silent symptom include speech therapy, behavior modification, psychoanalytic, psychotherapeutic, family systems and a combination of these approaches. This paper reviews the types of elective mutism and proposes common characteristics of elective mutists' families. The potential for a redefinition of the term “elective mutism” is examined. It is concluded that family dynamics are an integral part of the elective mutism problem and need to be considered in a comprehensive treatment plan.     

Youth Depression in the Family Context: Familial Risk Factors and Models of Treatment

Research on parent risk factors, family environment, and familial involvement in the treatment of depression in children and adolescents is integrated, providing an update to prior reviews on the topic. First, the psychosocial parent and family factors associated with youth depression are examined. The literature indicates that a broad array of parent and family factors is associated with youth risk for depression, ranging from parental pathology to parental cognitive style to family emotional climate. Next, treatment approaches for youth depression that have been empirically tested are described and then summarized in terms of their level of parent inclusion, including cognitive–behavioral therapy, interpersonal therapy, and family systems approaches. Families have mostly not been incorporated into clinical treatment research with depressed adolescents, with only 32% of treatments including parents in treatment in any capacity. Nonetheless, the overall effectiveness of treatments that involve children and adolescents exclusively is very similar to that of treatments that include parents as agents or facilitators of change. The article concludes with a discussion of the implications of these findings and directions for further research.     

Behavioral-Systems Marital Therapy: Dealing With Resistance

Recently there has been a dramatic increase in attempts to integrate certain intervention components of behavioral and systems approaches with marital and family therapy. This paper elaborates on a previously described behavioral-systems approach by focusing primarily on the issue of resistance to therapeutic progress within the behavioral framework. First, potential reasons for major resistance phenomena are suggested. Then, in the context of a social learning theory model of assessment and intervention, specific clinical indications are discussed for departing from the basic behavioral approach in order to deal with resistance. Finally, a variety of interpretive and strategic intervention techniques are described and illustrated by clinical case materials     

Culture,psychology and ecology: An interview with Theodore Roszak

Objectives: This study investigates the efficacy of a standard cognitive behavioral group-program for chronic pain, in comparison with the same group program that integrates an existential perspective at treatment conclusion, 3-month, and 6-month follow-up. Design: This study is a quasi-experimental clinical trial with two treatment groups. Methods: We included 113 patients suffering from chronic pain who had been accepted for treatment at an interdisciplinary pain center. In addition to the specific therapy program, the patients received intense interdisciplinary treatment. Outcome measures include both pain-related disability and pain severity. Repeated-measures analyses of variance (ANOVAs) were used to test statistical significance, followed by tests of simple contrasts with pre-treatment as a reference-point. Results: Results indicated that the integration of an existential perspective leads to significantly lowered pain-related disability than the classic cognitive behavioral group-program. Additionally, existential aspects seem to be particularly important for patients with a spiritual orientation. The findings from this study support the importance of considering specific existential aspects in the cognitive-behavioral approach in treating chronic illness.     

Treating Parents and Children Together

SUMMARY

In this paper I look at two traditions of psychotherapy with children: family therapy {here considered in its common paradigm of systems theory and not in its diversity of approaches) and individual psychodynamically oriented child therapy. The author examines how, in these two modalities of treatment, the real world of the parent-child relationship, which remains mostly a world of women and children, tends to be left out in practice. Many family therapists “exclude” children from their sessions and concentrate on the marital relationship while child therapists “exclude” parents from the core of the therapeutic process. The issues for therapists and the consequences for adults and children in families in this com-partmentalization of services are examined within a feminist framework. The development which is advocated is for therapists to expose themselves fully to the world of the parent-child relationship as a fust step in reexamining their stereotypical views of motherhood and fatherhood which trap women in conflicted and potentially exploitative situations and do not consider that children actively construct their own relationships.     

Concepts and methods of explicit marital negotiation training with the marriage contract game

Abstract

The Marriage Contract Game was designed to help couples negotiate relationship and task problems in an explicit, rational manner. This paper describes the game's conceptual ties to modes of behavioral family intervention and to the social psychology of bargaining. The game's procedures are described in detail to permit the replication and dismantling required for empirical investigation. The paper concludes with an example of the game's application to a distressed couple.     

Childhood exposure to emotional abuse and later life stress among Kenyan women: a mediation analysis of cross-sectional data

Background and objective: We explore whether perceived stress among Kenyan mothers is predicted by childhood exposure to emotional abuse – both witnessed among parents and experienced directly. Further, we explore whether this association is mediated by social support, family functioning and polygynous marriage.

Design: We used cross-sectional data from a systematic random sample (n?=?1974) of mothers in semi-rural Kenya.

Methods: Data were collected using validated scales and trained interviewers. Analyses were conducted using bootstrapped structural equation models and fixed-effects linear regression models, controlling for age and household wealth.

Results: Reported experience of emotional abuse – both directly experienced and observed among household adults – was high in the present population (72.5% and 69%, respectively). Perceived stress among women was significantly higher if they were exposed to more emotional abuse during childhood (p?<?.001). Lower social support, worse family functioning and higher rates of polygynous marriage mediated pathways between emotional abuse exposure during childhood and adult perceived stress.

Conclusion: Future research should investigate whether social integration, identity formation and self-esteem underlie observed dynamics in sub-Saharan Africa. Efforts to promote social integration and support should target children currently experiencing emotional abuse, and may include child-targeted high quality television programing and adult-targeted media and celebrity campaigns.     

Anorexia Nervosa: The Hospital's Role in Family Treatment

When an anorexia nervosa patient requires hospitalization for her ¹ 1 We will use the pronoun “her” to refer to anorexic patients since the overwhelming majority are female. Our discussion will focus mainly on younger adolescent girls who are still living with their families.
medical condition, the treatment team faces the problem of integrating the individual focus of inpatient care with the systems focus of family therapy. In this paper we propose a family-systems model of hospitalization, the aim of which is to facilitate such integration. The model draws on current theories of anorexia nervosa, as well as general concepts from psychodynamic, developmental, and family systems theories. The major hypothesis of the model is that all members of the anorexic family are developmentally arrested in the area of separation-individuation. On this assumption, we propose that the entire treatment team (including medical professionals and therapists) needs to function as “parents” to the anorexic family in much the same way that two cotherapists become parental figures in family therapy. Specifically, the team needs to provide those parenting responses that facilitate the family's individuation process.     

A Cybernetic Theory of Psychopathology

Abstract

Cybernetics, the study of principles governing goal-directed, self-regulating systems, offers a useful approach to understanding psychopathology or psychological dysfunction, overcoming limitations of other naturalistic approaches. Whereas influential theories of psychopathology have relied on definitions of dysfunction rooted in evolution and fitness, we define psychopathology in terms of cybernetic dysfunction, failure to make progress toward important goals. Cybernetic function in organisms is not identical to evolutionary function, despite their causal phylogenetic relationship. We define psychopathology as persistent failure to move toward one’s goals, due to failure to generate effective new goals, interpretations, or strategies when existing ones prove unsuccessful. This definition allows a thorough integration of dimensional approaches to psychopathology and personality and provides a new perspective on the nosology of mental disorder. We review evidence that the major dimensions of psychopathology correspond to major trait dimensions of personality, but we assert that extremity on these dimensions is neither necessary nor sufficient for psychopathology, which requires cybernetic dysfunction. Drawing from psychological and neurobiological research on personality and psychopathology, we present a theory of the mechanisms underlying the five major dimensions of psychopathology, some of their subdimensions, and the general risk factor for psychopathology. We conclude by discussing implications of our theory for research, diagnosis, and mental health interventions.