Family Augmented Cognitive Behavioural Therapy: Make Room for Mum!

Familial processes are gaining an increased amount of attention in cognitive behavioural therapy. Their role in initiating, maintaining, and exacerbating distress in children and adolescents has clear clinical implications. Therefore, including parents in their children’s therapy sessions as coaches, collaborators, and co-patients is becoming commonplace in CBT approaches to internalizing disorders such as anxiety. This article describes a case of a 13?year old female who presented with features of Generalized Anxiety Disorder and Separation Anxiety whose course of treatment involved her mother as a coach, collaborator and co-patient. A case formulation is offered and the specific examples of CBT practices used in each session are detailed. Ways of evaluating treatment outcome are also discussed.     

Spillover to triadic and dyadic systems in families with young children

Research has evidenced support for the spillover model, which asserts that parents' marital functioning influences their parenting and coparenting behavior in dyadic (mother-child and father-child) and triadic (mother-father-child) family contexts. However, few studies have simultaneously investigated the spillover model in both parenting and coparenting systems, preventing examination of whether spillover impacts both systems equally or differentially. Further, little research has examined whether quality of the marital system influences children's behavior toward their parents, as well as their parents' behavior, in dyadic interactions. We examined the spillover model using observational measures of parent and child behavior in parent-child dyadic interactions as well as coparenting in triadic interactions. We also explored parent and child gender differences in spillover effects. Participants were families with children aged 3 to 6 years (n = 149). Findings indicated that spillover occurs to multiple family systems, but the effects varied according to whose behavior (mother, father, child) was explored. In families of boys and girls, the marital system influenced warmth in triadic interactions, as well as fathers' responsiveness and children's responsiveness to mothers in dyadic interactions. Spillover effects were largely equivalent for girls and boys, but spillover to coparenting hostility in triadic interactions was limited to families raising girls. Parent gender also moderated associations between marital functioning and parent-child interactions: Spillover was significantly stronger for fathers' responsiveness (vs. mothers' responsiveness) and child responsiveness to mothers (vs. child responsiveness to fathers).     

Family functioning in families of children with anxiety disorders.

The authors examined maternal and paternal reports of family functioning and their relationship with child outcomes as well as the association between anxiety and depression in family members and family functioning. Results reveal that maternal and paternal reports of family functioning were both significantly associated with worse child outcomes, including child anxiety disorder (AD) severity, anxiety symptoms, and child global functioning. Maternal and paternal anxiety and depression predicted worse family functioning, whereas child report of anxiety and depression did not. Parents of children with ADs reported significantly worse family functioning and behavior control, but only fathers reported worse problem solving and affective involvement compared with fathers of children with no psychological disorders. Findings from this study suggest that paternal as well as maternal anxiety and depression play a role in worse family functioning in children with ADs and that unhealthier family functioning is associated with worse child outcomes in this population.     

The impact of young children with externalizing behaviors on their families

Compared the impact on families of young children with externalizing behaviors (e.g., hyperactive, aggressive; n=22), autism (n=20), or no significant problem behaviors (n=22) on several measures of family functioning. Previous studies have found heightened stress and parental maladjustment in families with externalizing children. The present study expanded upon that literature by (1) including a clinical control group to determine the specific impact of externalizing problems, (2) focusing on preschool aged children, and (3) using a new measure to directly ascertain parents' perception of impact. Compared to parents with normally developing children, parents with externalizing children reported more negative impact on social life, more negative and less positive feelings about parenting, and higher child-related stress. Moreover, parents of externalizing children reported levels of impact and stress as high as those reported by parents of children with autism. On broader measures of parental and marital wellbeing, however, the three groups of families of preschoolers did not differ. The implications of these findings for intervention are discussed.This research was conducted at the Fernald Child Study Center, University of California at Los Angeles. We wish to thank Jan Blacher, Doug Granger, Stephen Hinshaw, and Karen Rudolph for comments on an earlier version of this article, and Kenny Smith and Doug Granger for computer help. We also appreciate the assistance of our colleagues on the Preschool Project, Drew Erhardt, Tracy Heller, Barbara Henker, Alice Huber, Blair Paley, Karen Rudolph, and Jennifer Treuting.     

Family therapy with black families

Family therapy in Britain must develop to encompass the external reality of family life. Living in a racist society dominates the lives of all black families. Family therapists need to acknowledge and address this before intervening in the family system. This paper offers personal and professional experiences, confrontaion, structured exercises and general and specific principles for work with black families. Minimal and positive goals are advocated so that practitioners do not feel paralysed by the enormity of the task.     

Family therapy with one-parent families

In this article the author introduces an integrative approach to family therapy with one-parent families. This includes a diagnostic framework built on the developmental stages of the family, critical areas, and—most importantly—specific settings and therapeutic strategies based on the assumption that one-parent families can raise children as successfully as other families, but in a different manner.The term one-parent families is used in this article, although it is not the correct expression, simply because no child has only one parent. The term binuclear families does not fit with all of them, and single-parent-led families seems to be ambiguous but quite cumbersome to use.     

Applicability of the Impact on Family Scale for assessing families with behaviorally difficult children.

The present paper reports a series of studies on the potential usefulness of the Stein and Riessman Impact on Family Scale for assessing the effects of behaviorally difficult children on their families. Subjects were parents of 54 clinic and 76 nonclinic children who completed a child behavior or child temperament questionnaire in addition to the Impact on Family Scale. Findings suggest that, while the scale was developed for assessing the influence of a physically ill child on the family, this general assessment approach may also have value in assessing family-related changes associated with having a child who is difficult to look after.     

A computerized scoring procedure for the Kvebaek Family Sculpture Technique applied to families of children with rheumatic diseases.

A new computer-based quantification procedure was applied to data obtained from administering the Kvebaek Family Sculpture Technique (KFST) to 92 mothers of children with recent onset of rheumatic symptoms (median = 7 months). Four family configuration types (close, hierarchical, unspecified, and skewed) were defined on the basis of distance and structural parameters of the configuration. The types differed with regard to the childhood environment of the mother, chronic family difficulties, and the psychosocial functioning of the primary patient. Comparisons of the families of the mothers that did (n = 23) and did not (n = 69) wish a change of family configuration showed that the families of the mothers who wished change differed with regard to configuration types, distance variables, and psychosocial characteristics. The results are discussed in the context of structural family-systems theory. The computerized scoring procedure opens new possibilities for research about various family members' perspectives and assessment of changes in family configurations during therapy or over time.     

Revisiting the accuracy hypothesis in families of young children with conduct problems

Revisited the accuracy hypothesis in an examination of the relation between maternal depressive symptomatology and child conduct problems. All data were gathered as part of the pretreatment assessment in an outcome study of families with clinic-referred children with conduct problems (age 3 to 6). The mothers varied in their depressive symptomatology, from not at all symptomatic to severely symptomatic. Correlations indicated that with increasing depressive symptomatology, mothers (N = 97) displayed a higher rate of physical negative behaviors towards their child and reported more child conduct problems. Regression analyses revealed that at the lowest levels of maternal depressive symptomatology there was a discrepancy between mothers' reports of child behavior problems and child deviant behaviors observed during mother-child interaction. In contrast, at higher levels of depression, mothers' reports of child behavior were consistent with laboratory observations of their child's behavior. These findings provide evidence to support the accuracy hypothesis in reference to mothers who display a high degree of depressive symptomatology, but the results also call into question the validity of maternal report in families with children with conduct problems.     

Family functioning within the context of families with adolescent children in urban India

Research on family functioning within given cultural contexts is needed. This study aims to describe salient dimensions of family functioning in two urban contexts in India and to examine differences in family functioning by sociodemographic groups. We measured differences in family functioning using cross-sectional survey questionnaire data collected from 13 to 15-year-old adolescents and one of their parents/primary caregivers in Mumbai (n = 843) and Kolkata (n = 913) during 2019–2020. We drew a multi-stage sample representative of neighborhoods and households in both cities. We assessed a multi-dimensional family functioning latent factor that included parent-reported measures (parent–adolescent communication, family cohesion, and parent monitoring of peers) and adolescent-reported measures (parent support, family cohesion, and parent supervision). Our results support an overall measure of family functioning manifested by multiple dimensions for parent- and adolescent-reported data. Families with male adolescents had worse adolescent-reported family functioning in Mumbai and parent-reported family functioning in Kolkata. Higher socioeconomic status was associated with better parent-reported family functioning in both cities and better adolescent-reported family functioning in Kolkata. Muslim religious identification in Kolkata and the Hindi native language in both cities were associated with better adolescent-reported family functioning. Our findings indicate heterogeneity in family functioning across demographic and social-cultural groups within the two urban contexts of India. This study may inform the development of culturally congruent prevention interventions for families with adolescents in India.