Search Results

This chapter describes in detail the format, structure, and content areas of some of the major family psychoeducation (FPE) studies. Single and multi-family models and other adaptations are discussed. Initial research in the UK focused on reducing high expressed emotion (EE), but subsequently FPE was extended to low EE families as well based on families' self-assessed needs and problems. Seminal programs in the US evolved in Pittsburgh, California, and New York State. In Europe, the Optimal Treatment Project of Ian Falloon and associates continues as an international collaborative group to promote the routine use of evidence-based practices (EBPs) for schizophrenia in clinical facilities, including FPE. Large sample studies indicate the efficacy of these bundled optimal treatments. Miklowitz and Goldstein's Family Focused Treatment for bipolar disorder is described. A final section on long-term effects ranging from seven-year to eleven-year follow-ups, in Germany, the UK, and Italy, showed positive effects.

Couple and family therapy (CFT) is challenging because multiple interacting working alliances develop simultaneously and are heavily influenced by preexisting family dynamics. An original meta-analysis of twenty-four published CFT alliance-retention/outcome studies (k =17 family and 7 couple studies; N = 1,416 clients) showed a weighted aggregate r = .26. This medium effect size is almost identical to that reported for individual adult psychotherapy. In this chapter, we also summarize the most widely used alliance measures used in CFT research, provide an extended clinical example, and describe patient contributions to the developing alliance. Although few moderator or mediator studies have been conducted, the available literature points to three important alliance-related phenomena in CFT: the frequency of “split” or “unbalanced” alliances, the importance of ensuring safety, and the need to foster a strong within-family sense of purpose about the purpose, goals, and value of conjoint treatment. We conclude with a series of therapeutic practices predicated on the research evidence.

This chapter presents a possible model of therapies related to autism based both on assessed knowledge and direct experience. This chapter also considers the real reasons why — in contrast with other disabling conditions such as Down syndrome and epilepsy, where therapies and education are universally the same — autism is muddled by innumerable educational and rehabilitation methods. Topics discussed include the family, education, self and heteroaggression and fits of rage in subjects with autism, sleep disorders, nonspecific symptoms of autism, and specific treatments in autism.

This chapter compares different models of family interventions in serious mental illness. Family therapy has been based on a premise of systemic dysfunction, although some newer models question pre-existing pathology and focus on strengthening coping skills; family consultation is limited to helping families address specific concerns. Family psychoeducation (FPE) and family education (FE) have similar core content. However, FPE focuses on client outcome, while briefer FE, taught by trained family members, is designed to help key relatives understand and cope with the illness. Two other multi-family models include psychoeducational support groups, offered by some agencies as an ongoing supportive resource for clients' families or for the general public. Family support groups, which are also open ended and continuous, are usually extensions of advocacy groups such as NAMI or MHA. Some research data show positive effects of FE for participants. However, only FPE fully satisfies the EBP criteria established in the introduction for treatment of clients.

Rates of diagnosable anorexia nervosa (AN) and bulimia nervosa (BN) are low in youth because DSM criteria is not typically applicable to adolescents. Therefore, the majority of teens seeking treatment qualify for Eating Disorder Not Otherwise Specified. This chapter reviews the evidence basis for the treatment of eating disorders. The vast majority of studies on eating disorders pertain to adults, and there is a lack of study on AN, in general. The Maudsley Model of family therapy has received attention for adolescent AN but there is not yet convincing evidence that it is more effective than supportive therapy. Considering the adult literature, CBT, interpersonal therapy, and antidepressants may be helpful for bulimia symptoms in adolescence. More treatment outcome studies on adolescent eating disorders are needed before such manifestations develop into full-blown disorders and entrenched patterns of dysfunctional attitudes and behaviors result.

This chapter situates the emergence of family therapy in a postwar setting of several factors: the professional landscape and socially minded mission of psychiatry; a therapeutic ethos that grounds the solution to social problems in psychological treatment; and conflicting worries about the family—such as its capacity to foster racism, and the isolation and conformism of suburban families in mass society. The new techniques and practices developed by therapists for working with patients who no longer fit the psychoanalytic model of the individual plays a vital role in the field's formation. By shifting their clinical expertise from the individual to the family, early family therapists opened up space for a new set of practices that would then be appropriate for treating family-based disease.

This chapter evaluates whether families receiving solution-focused family therapy (SFFT) in home-based versus office-based settings differed on various treatment outcomes with troubled and runaway youth. Families were recruited from among those who sought family-based services at a community agency that focused on treating issues of family conflict. Families also sought assistance for difficulties associated with their adolescent child's runaway tendencies, truancy, and/or delinquent behaviors. The study evaluated differences between families receiving home-based versus office-based services on measures associated with the treatment process, including retention, goal attainment, engagement, counselor rapport, and satisfaction with services.

This book covers the family treatment practice theories that have begun to develop an evidence basis to support them. It not only reviews the research evidence to support these theories, but most importantly delineates how to implement them with problems that human service and mental health practitioners commonly see in today's practice settings. Theories discussed include psychoeducation, behavioral therapy, cognitive-behavioral therapy, solution-focused therapy, structural family therapy, and multisystemic therapy. The organization of the book is developmental stage (childhood, adolescence, adulthood, and older adulthood) and type of presenting problem (social problems and mental health disorders).

The solution-focused brief therapy (SFBT) model evolved out of the brief family therapy (BFT) approach between 1978 and 1984, long before the words evidence-based practice became an integral part of the medical and mental health vocabulary. At the beginning, the team at the Brief Family Therapy Center (BFTC) utilized a research approach that relied on clinical observations and client data to discover which therapeutic techniques would most effectively facilitate behavioral change. Only recently has SFBT been studied through the lens of efficacy research and evidence-based practice. This chapter chronicles how the original team members actually used an evidence-based process to develop the model; how the approach evolved from a brief family therapy model to a therapeutic approach that focuses on future solutions; and the specific theory and interventions that made SFBT both similar to and different from other therapies.

This chapter proposes a framework for the relational therapies that focus on the communal creation of meaning. The therapist is both the knitter and the yarns: singular, yet one of many. Just as family therapists took advantage of a newly seen unit, and the family, to enlarge their range of choices, so can postmodern therapists take advantage of the shift to the nonessentialist position of social construction theory. However, even that theory takes a backseat to a heightened interest in practice. Instead of asking, “What are the philosophical underpinnings of our work?”, we now ask “What is the knit one, purl two, of the kind of social knitting preferred by effective therapists of any school?” The nature of these more communal practices is considered within the historical context of the family therapy field.

This chapter covers multisystemic therapy, which is considered a form of family therapy but extends beyond it to the numerous systems in which the adolescent is embedded that serve to maintain and impact delinquent behavior. These systems include the individual youth, the parent, the peer group, the neighborhood, and the school setting. The chapter will be organized along goals and interventions at these system levels using a case study as a basis.

This chapter describes a family-based music therapy programme offered in schools in Limerick city, Ireland. Families experiencing risk and vulnerability due to their social, geographic, and economic circumstances have the opportunity to participate in a series of weekly music therapy sessions. This Irish school-based music therapy group programme was provided for the needs of marginalized or at-risk families. The programme was reported by teachers and caregivers to have improved the quality of relationships between caregivers and children. Relationships were nurtured and the development of stronger bonds was observed.

This chapter focuses on the visual technologies—particularly one-way mirrors and training films—that play a vital role in bringing together the realms of family life and therapeutic culture. It explores two domains in which family therapists incorporated these technologies: educational programs to train new family therapists, and research efforts to understand and treat delinquency as a clinical problem. Family therapists turned to visual technologies not just for their seeming objectivity and superiority in recounting family events or therapy sessions. They incorporated these technologies because such tools enabled them to engage with the performative dimensions of family pathology itself. Equipped with visual technologies, family therapy training programs, clinical practices, and research projects solidified this alignment of how to know and what to know.

Increased research on the caregiving process has led to rising concerns about its economic, social, and psychological impact. The information garnered has countered practice trends. The burgeoning of information about the impact of caregiving, and the increased recognition that informal caregiving is a typical family experience, has propelled practitioners and theorists alike to seek interventions that might alleviate caregiver stress. Consequently, family therapy and group treatments have become more commonplace. That is, practitioners have gradually adopted or modified traditional family and group clinical social work approaches thought to be effective with the general population for use with frail older adults and their caregivers. By the mid-1980s, a growing interest in caregiver support began to close the gap between what is known about family functioning and clinical practice. This chapter discusses the development and nature of those social work family and group interventions.

Discusses and illustrates three process models or psychotherapeutic approaches to teaching people how to forgive, developed by psychologists Robert Enright, Everett Worthington Jr., and Michael McCullough. These models emphasize the importance of cultivating the traits of empathy and of humility as essential to learning how to forgive. The chapter goes through each stage or phase of these models, and explains how they have been used in premarital, marital, and family counseling and therapy. While accepting most of the features of these approaches as valuable, the author critiques those aspects of them that presume certain Christian values which he considers to be morally or psychologically problematic, such as too little emphasis on justice and repentance in the models, and the goal of getting the victim to love the perpetrator of the injury to him, rather than merely to let go of the anger and resentment that he bears. The chapter concludes with a moving excerpt from the book “The Railway Man” by Eric Lomax, which describes the long psychological and spiritual journey of a British WW II POW who had been brutally tortured by his Japanese, towards forgiveness of the Japanese translator/interrogator who had been involved in the torture sessions and had spent all of the postwar years in remorse and repentance of, and vicarious restitution for his wartime misdeeds.

This chapter looks at how family therapists use the culture concept—elaborated by anthropologists such as Alfred Kroeber and Clyde Kluckhohn—to justify their own field and build a community of self-identified professionals. It discusses how therapists use culture to deal with conflicting ends in debates about universal versus relativistic characterizations of the family, the practicability of addressing problems through therapeutic means, and the advisability of promoting or challenging societal values and norms through family therapy. The vagueness of the concept of culture proved to be productive for the field because it enabled culture to serve as an explanatory framework for a wide variety of issues, such as the nature of prejudice and the relationship between family and poverty.

The family has long been recognized as the most effective, long-term institution for raising children. Adequately functioning families socialize children, transmit intergenerational values and beliefs, and provide a place of refuge from the challenges of the outside world. In cases where parental functioning is impaired and the family environment is chaotic, taking the child out of home for treatment either in traditional outpatient care or by temporarily removing him or her to a different, unfamiliar setting may fail to address the underlying systemic issues that affect the child's sense of self and ability to function autonomously. This chapter describes some of the characteristics of families for whom the home may be a preferred treatment site, reviews some of the literature on home-based preventive and intervention programs for high-risk children, and provides specific case examples drawn from both a family preservation program and a psychiatric service for children and adolescents with severe emotional disturbances, which are delivered in the child and family's home.

Psychological therapies are often the first-line treatments for psychi–atric disorders, depending on their nature and severity. In many cases they work best in conjunction with medication. The UK government is encouraging improved and timely access to psychological treatments in both primary and secondary care services. Psychological treatments can be carried out in community mental health services, specialist psycho–therapy services, and the private sector. Psychological therapies have a rich history. Today a number of evidence-based, innovative treatments are available. There is advanced research in psychotherapy, which comes with its own challenges. Psychotherapies can be delivered to individuals, families, couples, or groups. They can be as short as a few sessions or can last for more than a year, depending on the modality. The focus may be varied, such as anxiety symptoms, specific phobias, relationship problems, mood distur–bances, or difficult life events. Psychodynamic psychotherapy gives people a fixed time to think—and talk—about the feelings we all have about ourselves and other peo–ple such as family or close ones. CBT focuses on how we think about the things going on in our life—thoughts, images, beliefs, and attitudes (cognitive processes)—and how this impacts the way we behave and deal with emotional problems. Family therapy looks at the family as a system and works on each individual’s relationship with others and involvement with the problem.

This introductory chapter explains the rationale for examining how families became a site of disease and an appropriate point of intervention during mid-century America. It operates across three interconnected areas: the history of family therapy's formation, the history of postwar American cultural and intellectual life, and the history of scientific observation. Pessimistic concerns about the state of the American family are combined with optimistic confidence in the potential for expert assistance, including the capacity of family therapists to use therapeutic means to address severe pathologies. The fact that the family is seen as a vessel of hopes and problems—from schizophrenia and delinquency to the state of national democracy and military strength—underlines the stakes of approaching the family as a site for therapeutic intervention.