Effects of family therapy for substance abuse: A systematic review of recent research

One of the most serious psychosocial problems worldwide is substance abuse because of its repercussions not only on the physical and psychological health of the abuser but also on their relational functioning. Among the well-established therapeutic approaches for the treatment of substance abuse is family therapy, which, in addition to influencing personal variables, promotes changes in family dynamics. The main objective of this study is to review the scientific literature published from 2010 to the present on the efficacy and effectiveness shown by family-based treatment approaches for substance use problems both in adolescent and adult samples. In addition, the effect on secondary variables such as family functioning and behavioral problems is evaluated. The empirical evidence accumulated in the last decade and reviewed in the present study indicates that the incorporation of family members in the treatment of substance abuse produces benefits by diminishing consumption and improving family functioning. Limitations of this study and of the research reviewed are discussed and directions for future research are provided.     

Dance becomes therapeutic in the mid to late 20th century

The convergence of dance art and therapeutic culture engendered the development of dance-movement therapy in the mid to late 20th century internationally. This article traces the sociopolitical, institutional, and aesthetic influences that coalesced in this process by contrasting histories of dance-movement therapy in Hungary and in the United States. The professionalization dance-movement therapy, through which it established its own theory, practice, and training institutions, occurred first in the United States in the late 1940s. Modern dancers in the United States began to conceptualize their activity as therapeutic, and the dancer as a (secular) healer, a therapist. The influx of therapeutic concepts into the field of dance is viewed as an example of therapeutic discourse permeating various areas of life in the 20th century. The Hungarian case provides a contrasting history of therapeutic culture, one that deviates from the predominant view of the phenomenon as a product of the global spread of Western modernization and the growth of free-market capitalism. Hungarian movement and dance therapy indeed developed independently from its American predecessor. Its history is intimately tied to the sociopolitical context of state-socialist period, particularly to the institutionalization of psychotherapy in public hospitals, and to the adaptation of Western group psychotherapies within the informal setting of the “second public sphere.” The legacy of Michael Balint and the British object-relations school provided its theoretical framework. Its methodology was rooted in postmodern dance. The methodological differences between American dance-movement therapy and the Hungarian method reflects the shift in dance aesthetics that occurred internationally between 1940 and 1980s.     

Clinician experiences of homework in couples and family therapy: A survey of perceived impact on the working alliance

The process of engaging clients in homework assignments has been studied extensively in research settings, but rarely have the challenges in the implementation of the science been considered in couples and family therapy. A survey was conducted of 226 clinicians regarding (1) their experience of homework adherence (quantity and quality) with couple and family clients, and (2) their experience of the impact of homework non-completion (IHN) on the working alliance. Clinicians working with families reported less overall homework quantity and quality. However, across both couples and family clients, more negative IHN was reported among clinicians experiencing less homework quantity, both in terms of IHN bond (couple ρ = 0.71, p < 0.001; family ρ = 0.78, p < 0.001) and IHN agreement (couples ρ = 0.25, p < 0.001; ρ = 0.19, p = 0.006), and among clinicians with fewer years of clinical experience (r = 0.19, n = 136, p < 0.05). The present findings suggest that, in the context of couples and family therapy, there is a risk of perceived negative IHN on the working alliance. There would be merit to future investigations examining the processes of facilitating homework engagement within the context of a strong working alliance.     

When left hands touch: shadow vows and Jung’s quaternity

Is there a connection between the exchange of vows and the fighting and suffering of couples that are unique to the institution of marriage? This essay introduces the concept of Shadow Vows, the unacknowledged assumptions, agreements, and obligations each partner brings to the relationship, which the authors believe are often responsible for longstanding marital discord and strife. The authors ground the existence of shadow vows in Jung’s quaternity, alchemy, typology, archetypal theory, and depth approaches to couple therapy. The essay concludes with a list of themes indicative of shadow vow enactments in clinical work with couples.     

Intensive specialised multi-family therapy for multi-stressed families: Therapeutic alliance as predictor for effectiveness

The effectiveness of intense specialised multi-family therapy (ISMFT) for 111 multi-stressed families, and the therapeutic alliance as a possible predictor of outcome, were examined. A repeated measures design was used, where changes in all ISMFT phases (preparation, multi-family therapy and follow-up) were assessed and compared for both mothers and fathers. Evidence was found for improved family functioning after the therapy period, which was maintained at 3 months follow-up, although the multi-stressed families still functioned in the problematic range. The therapy did however not decrease parenting stress, or did so only temporarily. Observations of the therapeutic alliance with the System for Observing Family Therapy Alliances (SOFTA) scales indicated that high therapist engagement was related to positive therapy outcomes, both at the start of therapy and later. High family engagement also predicted therapy effectiveness, but only at the start of therapy. The present study shows that solution-focused multi-family therapy at least seems to provide the first step in alleviating problems in multi-stressed families.     

Conceptualising,designing and drafting a monthly multi-family therapy programme and manual for adolescents with anorexia nervosa

The written transmission of therapists' expertise in manuals is an important issue which is highlighted in the literature. Manuals are essential for research, training and therapeutic guidance. However, the conceptualisation, design and drafting of therapy manuals have received little attention. Our team conceptualised and designed a 10-monthly session multi-family therapy programme for adolescents suffering from anorexia nervosa. This paper presents the methodology used to evolve from training and theoretical models to designing a programme and drafting the accompanying manual. We then describe how our team reached a consensus regarding the role to be attributed to food-related symptoms in the programme. These arduous tasks were rewarded by fruitful discussions among team members, which led to a shared theory of treatment. The methodology presented here is drawn from both the experience of specialised teams and from that of families in providing care to adolescents with anorexia nervosa.     

Year of Zoom in a Year of Doom: Lessons Learned Delivering ERP Remotely During the COVID-19 Pandemic

In response to the COVID-19 pandemic and consequential shutdown measures, many mental health professionals started providing therapy to patients exclusively via telehealth. Our research center, which specializes in studying and treating obsessive-compulsive disorder (OCD), historically has provided in-person exposure and response prevention (ERP) to adults with OCD, but shifted to telehealth during the pandemic. Unlike in other modes of talk therapy, ERP’s emphasis on therapist-supervised exposures presented unique opportunities and challenges to delivering treatment entirely via a virtual platform. This paper provides case examples to illustrate lessons we learned delivering ERP exclusively via telehealth in New York from March 2020 through June 2021 and offers recommendations for future study and practice. Though we observed a number of drawbacks to fully remote ERP, we also discovered advantages to delivering ERP this way, meriting additional research attention.     

Post-Admission Cognitive Therapy for a Transgender Service Member With a Recent Suicidal Crisis: A Case Study of Gender-Affirming Care

While elevated suicide risk in the American military and veteran population has led to the development of targeted interventions, the increased risk of suicidal ideation and behavior among transgender and gender diverse (TGD) Service members requires that interventions address suicide risk within the context of minority stressors and gender-affirming care. This case study presents Jordan (an alias), a transgender Service member who received inpatient psychiatric treatment following a suicide attempt precipitated by distress relating to gender dysphoria, minority status, and associated stressors. Jordan completed Post-Admission Cognitive Therapy (PACT; Ghahramanlou-Holloway, Cox, & Greene, 2012), a cognitive-behavioral intervention targeting suicide risk among military personnel and dependents psychiatrically hospitalized following a suicidal crisis. Within the context of PACT, Jordan’s treatment included identifying and addressing distress related to minority stressors (externalized stigma, internalized transphobia, anticipated rejection, gender concealment) using gender-affirming best practices. Marked changes in Jordan's self-report measures from baseline to follow-up, as well as qualitative changes reported by Jordan, demonstrate that she felt comfortable, safe, and ready to be discharged from the inpatient unit after completing PACT treatment and gaining exposure to the skills necessary to help prevent and/or manage future suicidal crises. Treatment implications and recommendations for addressing suicide risk within the context of gender-affirming care and prevalent minority stressors are discussed.     

“It's wrong to relax,you have to be on the go,go, go,all the time”: Emotional transformation in a case of emotion-focused therapy for generalised anxiety disorder

Generalised anxiety disorder (GAD) is a highly prevalent, chronic and impairing disorder. The aim of this study was to qualitatively describe the transformation in emotional processing across 16 sessions of a successful emotion-focused therapy (EFT) treatment for GAD. A theoretical framework derived from the EFT model of in-session emotional transformation proposed by Pascual-Leone and Greenberg was used as the basis for qualitative analysis. Additionally, the Classification of Affective Meaning States, the Client-Expressed Arousal Scale-III and the Client Emotional Productivity Scale-Revised were utilised by observer–raters to classify moment-by-moment shifts in client affective-meaning states, emotional arousal and emotional productivity. Results supported the emotion transformation model. The client presented in a state of poorly differentiated but highly aroused distress provoked by identifiable interpersonal and intrapersonal triggers. Emotional and behavioural avoidance provoked by fear of pain was evident. Accessing core pain and responding to attendant needs with compassion and protective anger was shown to facilitate the higher order emotional processing states of grief, relief and agency. Implications are proposed, including that addressing core emotional vulnerability may be a critical intervention in the successful treatment of GAD.