Familjeinteraktion och familjeterapi vid psykosomatisk sjukdom hos barn: En familje- och systemorienterad syn på sjukdom

Abstract

Gustafsson P A. Familjeinteraktion och familjeterapi vid psykosomatisk sjukdom hos barn. En familje- och systemorienterad syn på sjukdom.Different aspects of the family system approach to childhood psychosomatic and chronic disease are evaluated. A rating scale for family interaction assessment is developed and validated, theories of family interaction patterns in the families of children with psychosomatic and somatic symptoms are empirically investigated as well as the efficiency of family therapy. The therapeutic process in family therapy is also briefly discussed. A group of families whose children were patients at a child and adolescent psychiatric outpatient department significantly (p < 0.01) more often had “extreme” (dysfunctional) patterns of familiy interaction (rigid or chaotic, disengaged or enmeshed, indistinct generational boundaries) compared with families in which the children had neither psychiatric nor psychosomatic symptoms. Family interaction patterns were evaluated in 22 families of children with severe, chronic bronchial asthma and were found to be significantly (p < 0.01) more disturbed in this group compared to 30 families of children with diabetes mellitus and 6 families with healthy children. A prospective study was made of the role of family interaction for metabolic balance in 30 families of children with diabetes. After 5 years, levels of HbA1 were significantly (p<0.05) higher in the children whose families initially had been considered to have dysfunctional interaction patterns. A controlled study of family therapy in 20 families of children with severe asthma was made. Improvement in the clinically most important variable, i.e. general pediatric assessment, was significantly (p<0.05) greater in the children in the family therapy group compared to the control group. Of the 12 children who received family therapy 11 showed significant improvement at the follow-up (p<0.01). The effects of family oriented child psychiatric treatment of 42 children with psychosomatic or somatic disorders on the amount of pediatric hospitalization were evaluated in a retrospective study. Attitudes towards the treatment were also asked for. In total, hospitalization days were reduced by 75% and medical care costs by 15% for the treated children, while there was a slight increase of hospitalization days and costs for the controls (p<0.001). In the same study about 2/3 of the treated families felt they had received help and understanding. They would want the same kind of help again if needed, and would readily recommend the treatment to others. To get an understanding of the kind of therapeutic interventions that were used, and that had caused positive treatment effects, certain family therapy sessions in the asthma study were video-recorded. It was found that an active approach, where the therapists counducted the therapy sessions with focus on the symptoms of the child and gave directives for behaviour change, was superior to a less structured technique. It was concluded that child-psychiatric liaison to pediatrics and a family systems approach to childhood psychosomatic diseases seem in many aspects to be beneficial for the children and their families.Bronchial asthma, Children and adolescents, Family therapy, Health economics, Hospital care, Juvenile diabetes mellitus, Psychological tests, Psychosomatic disease, Predictive measures.