A family systems framework for intervention with individuals

This paper outlines a model for working contextually with individuals. Family work with individuals is contrasted with the prevailing psychological theories which inform individual counselling and therapy. A framework is provided which draws upon a number of approaches derived from family systems theory. Brief illustrative vignettes support the discussion.     

Early intervention in the family system: A framework and review

A framework for understanding the effect of early intervention on family structure and functioning is presented. The framework uses five sets of variables to characterize families: Their ecology; and the values, roles, personalities, and interactions of family members. Twenty research studies that met criteria of having comparison/control groups, beginning intervention either prenatally or during the first 3 months of infancy, and directing intervention to family functioning are abstracted and examined in detail. Successful and unsuccessful studies are compared as to population and nature of intervention. Two criteria of success are used: (1) The commonly used criterion of any positive change; (2) a more rigorous criterion of change in at least three areas of family functioning, based on the assumption that more pervasive change will have more lasting influence on child development. Application of the first criterion found that 75% of early family focused intervention studies showed a successful outcome. Application of the latter criterion found that 50% showed a successful outcome. Further, there were no significant differences between successful and unsuccessful studies as to target group or type of intervention. The review suggests that early intervention targeted at family functioning is effective and that a more pervasive and sustained effect is likely if the intervention includes at least 11 or more contacts over at least a 3-month period.     

Pastoral consultation through a community Mental Health Center

Conclusion Pastoral consultation through a mental health center in Kansas has been a beneficial experience for participating clergymen and the mental health center staff. This consultation has provided interested clergymen an opportunity to learn effective ways of serving parishioners through the church. The clergymen and mental health center staff have also begun to realize the mental health implications of religious resources, as well as ways in which ministers and the mental health center staff can effectively work together in serving troubled individuals within the local community. Pastoral consultation may become a means through which other community mental health centers and local clergymen can form meaningful professional relationships. The continuance of a pastoral consultation program over a longer period of time is needed to determine its possibilities and liabilities for assistingA report of one aspect of a special study project on Community Clergy and Mental Health, made possible by a grant from W. Clement Stone to the Menninger Foundation.     

Intensive family therapy: a way to change family functioning in multi-problem families

TA single group treatment outcome study of intensive family therapy (IFT) is presented. One hundred and nine families from five Swedish units participated and results on family measures for eighty-six of these families are reported. This multi-centre study is the largest so far of this treatment model. The units offered a full-day multi-impact treatment programme for families during an intensive period of approximately one month preceded by a period of extensive planning. Measures used were the self-rating 'Family Climate' and Family Relation Scale and observer-rated CRS-Turbo and the Beavers' System Scales. Significant changes in the direction towards a better family climate and a higher family functioning occurred. Given the very difficult circumstances of these multi-problem families the results are considered promising.     

Cultivating ethics consultation: commentary on "The development of a clinical ethics consultation service in a community hospital

Conclusion: Simpson's article [in this issue, p. 124-130] provides us with needed data about the development and utilization of an ethics consultation service in a community hospital. It makes clear, however, how much further we have to go in developing guiding standards for practitioners and institutions. We need to learn much more about the effectiveness of ethics consultation in meeting well-defined goals and producing desired processes and outcomes before standards for credentials and accountability have a sound empirical basis.     

Anticipatory loss: a family systems developmental framework

This article provides a family-systems developmental framework for anticipatory loss in situations of physical illness, disability, and long-term psychiatric disorders, and offers a conceptual base for theory building, clinical practice, and research. A family systems-illness model that integrates psychosocial types and phases of illness with family variables, in particular, developmental patterns and beliefs systems, provides a foundation to rethink and expand our approaches to threatened loss.     

Research as a family therapy intervention technique

The utilization of the research process as an intervention has recently been described in the family therapy literature. However, it is important to draw a distinction between research as intervention and research as a unique family therapy intervention technique. From a family systems perspective, research as an intervention technique may make therapy more palatable for some families. A case study is presented in which this technique created the context for change for a family involved in a chronic illness research project.The author would like to thank Dr. Wendy L. Watson for her participation as a member of the clinical team and Drs. Fabie Duhamel and Wendy L. Watson for their helpful critiques on earlier drafts of this paper.Supported by a grant from the Albert Foundation for Nursing Research.     

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.     

Parental illness and disability: a family systems framework

Coping with the strains and uncertainties of parental illness and disability can be a monumental challenge. The Family Systems-Illness Model offers a psychosocial map to address this challenge and make the inevitable strains more manageable. Attending to the longitudinal psychosocial pattern of a condition within a multigenerational, life cycle and belief system context can provide the kind of structure – a common language that facilitates collaborative, creative problem solving and quality of life for families where a parent has a serious health problem. Some of the major challenges in families facing parental illness are addressed.     

Conservation of resources in community intervention

Evaluated the applications of principles of resource conservation and management in community interventions and compared these to a more individual, perception-based psychological perspective. Conservation of resource theory suggests that promotion of well-being and prevention of disease depend on the availability and successful management of resources. When resources are lacking, lost, or when invested without consequent gain, people become vulnerable to psychological and physical disorder and debilitated functioning. Resources, in this context, are defined as those things people value or those things that may help people obtain that which they value. Conservation of resource theory further suggests that resources are to a large extent common to all people, more common within a given culture and time in the developmental cycle, and only to a small extent idiographic. Further, conservation of resource theory posits that resources operate within an ecological context where feedback, sharing, and exchange operate between the individual, social context, and environment. Given these principles, it is reasoned that community interventions must acknowledge the solid base of most problems and accept that interventions must target resources and be intensive enough to change the ecology in which resources operate.     

Exercise motivation in university community members: a behavioural intervention

The purpose of this study was to examine how exercise level, exercise motives, and barriers changed from the baseline phase to the follow-up phase after a behavioural and cognitive intervention aimed at increasing exercise. Seventy-five members of our university community (43 subjects in the control group and 32 in the experimental group), all of whom received cognitive feedback, agreed to complete the baseline phase. Only the experimental group received behavioural feedback and a free-access gym ticket with personal training in order to facilitate their adherence to exercise. The results suggest that a combination of behavioural and psychological techniques is an efficient strategy for increasing exercise level. In addition, the results showed that extrinsic motivation predominates the early stages of change-of-exercise behaviour, and that intrinsic motivation is important for progression towards maintenance. Subjects who decreased their exercise level increased their extrinsic exercise motivation and subjects who increased their exercise level decreased the barriers related to intrinsic motivation. These findings indicate that, in order to facilitate exercise adherence, feedback about motives for undertaking exercise is needed, combined with advice about how to improve physical condition. This combination could help eliminate certain barriers that hinder engaging in an active and healthy life-style.     

The family check-up: a pilot study of a brief intervention to improve family functioning in adults

Many barriers exist for families seeking appropriate treatment for family problems. In an effort to minimize some of these barriers, we developed the Family Check-Up, a brief two-session family intervention. The Family Check-Up is based on the Drinker's Check-Up and consists of assessment, feedback, discussion, and goal setting. The purpose of the intervention is to help families identify and become motivated to make needed changes in any aspect of their family functioning. We conducted an open pilot trial of the Family Check-Up with 32 families. Our data suggest that the Family Check-Up (1) is sought out by the target audience, namely those with family problems; (2) is sought out by people with elevated depression symptoms or a history of treatment for depression or anxiety; (3) is feasible to conduct; (4) is acceptable to families; and (5) may be associated with changes in family functioning and depression symptoms over time. These results suggest that further research, particularly a randomized clinical trial, is warranted.