Family Sessions Research Articles

Predictors of Participation in an eHealth, Family-Based Preventive Intervention for Hispanic Youth.

The Familias Unidas intervention is an efficacious family-based preventive intervention for reducing substance use and other health risks among Hispanic youth. A current randomized controlled trial (RCT) is examining this intervention's efficacy when delivered via the Internet (eHealth). eHealth interventions can overcome logistical barriers to participation, yet there is limited information about the feasibility of these interventions, especially among ethnic minorities. This paper examines participation and predictors of participation in the eHealth Familias Unidas intervention in a sample of 113 Hispanic families whose adolescent had behavioral problems. Analyses examined multidimensional ways of characterizing participation, including the following: (1) total intervention participation, (2) initial engagement (participating in at least one of the first three intervention sessions), (3) completing the pre-recorded, eHealth parent group sessions, and (4) participating in the live, facilitator-led, eHealth family sessions. Participation in this eHealth intervention was comparable to, and in most cases higher than, previous, face-to-face Familias Unidas interventions. High levels of baseline family stress were associated with lower initial engagement and lower family session participation. Greater parental Hispanicism was associated with more participation in eHealth parent group sessions and across the total intervention. Higher levels of baseline effective parenting, in other words less intervention need, were significantly associated with lower levels of total intervention participation and lower levels of family session participation. Implications for preventive interventions delivered via Internet are discussed.

Treatment Overview of an Intensive Group Outpatient Cognitive-Behavioral Therapy for Youth Anxiety Disorders and Obsessive-Compulsive Disorder

ABSTRACTEvidence-based outpatient treatment protocols for anxiety disorders and obsessive-compulsive disorder have been demonstrated to be helpful for about half of children; however, a significant portion of treatment-seeking youth remain symptomatic and with impaired functioning. Innovations in the delivery of cognitive-behavioral treatments may allow for enhanced effectiveness. This article describes the design and implementation of an intensive, group-based cognitive-behavioral therapy program with a focus on exposure and response prevention for youth (ages 7–19) with anxiety disorders and obsessive-compulsive disorder. The multicomponent treatment involves psychoeducational groups, graduated in vivo exposure, family sessions, parent guidance groups, and psychopharmacologic consultation. Youth participate in treatment 4 times per week (3 group days and 1 family treatment day), for 2½ to 3 hr per day, for at least 4 weeks. In this article we provide preliminary outcomes and describe plans for evaluating the treatment more comprehensively.

Behandlung von Eltern-Jugendlichen-Konflikten nach dem Therapieprogramm für Jugendliche mit Selbstwert-, Leistungs- und Beziehungsstörungen (SELBST) – Konzeption und Ergebnisse einer Pilotstudie

Parent-adolescent conflicts often comprise the reasons for the referral of adolescents in treatment facilities. However, studies on the effects of behavioral interventions with this indication are rarely published, even in the international literature. In an explorative study, we assessed the efficacy and the acceptance of systemic-behavioral treatment modules of the treatment program for adolescents with disturbances of self-esteem, performance and relationships (SELBST). Ten adolescents aged 12 to 18 years (mean age 14,7 years) and their parents with severe parent-adolescents conflicts according to clinical judgment and with increased parent and adolescent ratings of conflicts on the Conflict-Behavior-Questionnaire-Cologne were included in the study. Analyses of pre to post changes showed a reduction in conflicts and/or an increase in conflict-solving skills as rated by the parents on various outcome measures. However, parents had problems attending the family sessions regularly and to implement therapeutic tasks in the daily family routine which may have limited the effects of the intervention. There is preliminary evidence that SELBST is a useful program for the treatment of parent-adolescent conflicts. To further increase the effectiveness of the program, knowledge from this trial has been considered in the development of the manual.

Searching for the Seeds of Psychosis.

In 1979, as I entered medical school to find the cause of psychosis, this journal was reviewing a report by Ralph Wharton on the “accidental treatment of thyrotoxicosis as mania” (1). Bothmy career and this report weremotivated by the enigmatic illness of a brilliant young woman, my sister Eileen. The onset of psychosis in a young person terrifies, consumes, and confounds the family. Almost always, as in my experience, there is no family history of severemental illness or personal experience with psychotic individuals. Eileen’s perception that she could hear our neighbors commenting on her behavior through the walls or that helicopters were flying overhead to monitor her conversations blindsided us. Of course, the ensuing hours and days of conversations thatwehadwithEileencouldnotdissuadeher from these hallucinations and delusions. Moreover, she stopped eating and sleeping and was agitated and terrified and then combative. She was admitted to a local hospital and diagnosed with schizophrenia. When told that Eileen would never be well and should be institutionalized, my mother, an army nurse, immediately arranged to have her discharged against medical advice, and my mother designed her own treatment plan. I know all too well the acute trauma that family members experience at the onset of a psychosis in a child. I now also understand their denial and the potential for displaced anger at treatment teams. Skillful clinicians can manage this circumstance, but in those days the family was viewed as the causative agent and not as an ally for the patient’s recovery. Eileen did not follow through on the full college scholarships she had earned to Clark or Colgate, but instead entered Rutgers, closer to home. Surprisingly, she did not miss an academic beat between her high school graduation and college entrance the next fall, but, oh, what a summer it was! In thesemonthsmyownlife and trajectorywerepermanently transformed. Not more so than Eileen’s, however. She would eventually graduate from college but experience another dozen hospitalizations along the way, each involving very severe symptoms, massive family efforts to get her to safety, and more and more bafflement about the disease. At each improvement we convinced ourselves the illness had ended, only to have the roller coaster ride begin again. Family sessions emphasized my mother’s role in producingEileen’s illness, in keepingwith the theories of theday. My dear mother’s ensuing guilt and despair consumed her spirit and the astounding resilience she had displayed against the substantial hardships in her own life.My fatherwithdrew as well, his war-related PTSD left him incapable of managing this family-based trauma, and I was left to step up to the task as best I could. A turning point in all these eventswas the recognition that her episodes were accompanied by thyroid storms and that she had Graves’ disease. She was transferred to a special unit at Columbia Presbyterian Medical Center and made an excellent recovery, as described in Wharton’s case report (1). The psychiatric team predicted that she would be cured through careful endocrine management. This was sadly not the case, and the hope for a quick medical cure soon faded. I decided to devotemy career to this cause, leaving a pharmaceutical research position to go to medical school. I eventually completed my psychiatry residency at Columbia University, beginningmy trainingon that same special unit where Eileen had been treated. For many years I considered her autoimmune thyroid disease to be a red herring, an unfortunate coincidence and just more bad luck for Eileen. Her clinical diagnoses swung through the typical suspects for psychosis: from schizophrenia to bipolar disorder, to schizoaffective disorder, and back again. She did eventually achieve a full remission on a combination of lithium and clozapine. For a whole decade she enjoyed health and happiness until her lurking immune condition again got the better of her. She rapidly plummeted into acute idiopathic renal failure. A successful kidney transplant followed, but clinical caution prevented the implementation of her previously successful treatment regimen, and her rocky course resumed. I have wrestled with the possibility that each putative etiological pathway that has been associated with psychosis might underlie Eileen’s condition. As a scientist I have enlightened myself about most of them and investigated a surprising number of the pathways myself. I am left thinking that the association of her particular disease with an autoimmune thyroid condition, as described in this journal by Ralph Wharton (1), offered the best clue. The psychoses are enigmatic and heterogeneous. We are now looking forward to person-specific cures, and abnormalities in immune activation should soon be measurable targets for treating psychiatric diseases. I hope this will be true in Eileen’s lifetime. I know all too well the acute trauma that family members experience at the onset of a psychosis in a child.

The Genogram in Helping Relationship

The Genogram is a graphical tool used by family therapists to systematize the chronologically and the composition of the family in question and parental relationships within it. The family therapist draws the genogram of the family and analyzing it as a team, draws on assumptions and dysfunctional aspects of strategic solutions that will then occur in session. The Genogram certainly draws from the idea of genealogical tree, but its attribution of authorship is clearly not shared. According to Anne A. Shutzenberger [1], for some it is traced back to Genososciogramma Henry Collomb, from genealogy (family tree) and Sociogram (representation of links and relationships), which he developed in Dakar and exhibited in Nice in 1978, starting from the reflections JL Moreno; for others it is traced back to Murray Bowen (referring to the conference on family therapy in 1967) and then to the conceptualization of the Group of Palo Alto [2] in California. In fact, for both processing paths of the genogram, distances seem shorter epistemological finding themselves in a ring of union in Frieda Fromm-Reichman, the first researcher who started filming family sessions with schizophrenic patients in 1948, and that in 1956 has worked with Moreno in Stanford [3] writing a book with him for four hands [4], with which the Group of Palo Alto [5], marking the birth of the Family Therapy. In truth, says still Shutzenberger, the genesis of Genogram seems to be rooted in the oldest soils, contains itself the concepts of "das Umbewusste" and "Collective Psyche" by S. Freud, and of "collective unconscious" of CG Jung.

Bringing forth stories of blame and shame in dialogues with families affected by adolescent self‐harm

Feelings of blame and shame seemed to figure significantly in the interactional patterns of some families seen within the self‐harm intervention family therapy (SHIFT) trial. Taking the SHIFT manual as a starting point, we elaborate the links between blame, shame, emotional regulation and adolescent self‐harm, drawing on various theoretical models. We note the importance of attending to these emotional processes both in the family and the therapy team, arguing that these unhelpful patterns of interaction, emotion and meaning‐making may also signal a motivation for change. We offer some ideas about using blame and shame as platforms for understanding and intervention in the context of adolescent self‐harm and illustrate the application of these ideas with case vignettes.Practitioner points Consider offering the young person and parents parallel sessions to scaffold better communication in family sessions. If you can, work with a team to help reflect on your own emotional responses and their meanings. When attempts to lessen blame provoke more, try to understand what underlies blaming behaviour. When a family's reported lack of difficulties seems incongruent with the presence of self‐harm, consider the possible silencing effect of shame.

Tangible Needs and External Stressors Faced by Chinese American Families with a Member Having Schizophrenia.

This article examines the tangible needs and external stressors experienced by Chinese American families with a member living with schizophrenia, in the context of a six-month pilot study of family psychoeducation. Therapists' notes from 117 family and group sessions were analyzed. The families expressed concerns regarding housing, finance, work, study, and the shortage of bilingual psychosocial services. Interacting with government offices and social services agencies caused anxiety and frustration, partly due to the high stakes involved given their low socioeconomic status, and partly due to the bureaucracy. As immigrants, study participants had needs for language translation, knowledge about resources, and advocacy by case managers. This study also highlights the importance of interventions beyond the micro individual level to the mezzo and macro levels, where changes in organizations and policies are necessary.

Badanie przebiegu terapii rodzin – prace nad polską wersją narzędzia SCORE-15

The aim of the paper is to demonstrate progress of the works on the Polish version of SCORE-15 and the results of the preliminary data analysis of changes in the process of family therapy, obtained with this tool. The works on the Polish version, ongoing since 2010, were inspired by the Research Committee European Family Therapy Association EFTA. Since the Polish version of SCORE-15 will be make public and published on EFTA website in the near future, therefore, it is important that people interested in the tool know the context of its development. The Polish version of SCORE-15, the tool designed to examine the process of family therapy, was used. The comparison of the results obtained by family members before the first family session and before the fourth one and psychotherapists' assessments show that the perception of the weight of the problem with which the family members came to therapy is indeed significantly lower already after three sessions of family therapy. Additionally, the obtained results show great coherence of the assessment of the family therapy progress in families and their therapists. The preliminary analysis of data obtained during the research project conducted in Outpatient Family Therapy Clinic, Department of Adult, Child and Adolescent Psychiatry, University Hospital in Krakow and in Laboratory of Psychology and Systemic Psychotherapy, Department of Child and Adolescent Psychiatry, Jagiellonian University Medical College between 2010 and 2014 revealed that SCORE-15 is a useful tool in research on changes in the systemic family therapy process.

Culture- and Immigration-Related Stress Faced by Chinese American Families with a Patient Having Schizophrenia.

The impact of culture and immigration on the experience of Chinese American families with a member having schizophrenia is explored within the frameworks of family systems and stress and coping. This qualitative study was conducted within an intervention study of family psychoeducation using therapists' session notes from 103 family sessions and 13 relatives' group sessions from nine patients and 19 relatives. The high stigma attached to mental illness leading to social isolation, and families' devotion to caregiving exacerbated caregiver burden. Taboo against discussing dating and sexuality and the consideration of arranged marriages caused unique stress. The insecurity as immigrants and shortage of bilingual services were related to greater enmeshment within these families. Implications on research methodology and practice are discussed.

Working in a family therapy setting with families where a parent has a mental illness: practice dilemmas and strategies

There is strong evidence supporting the benefits of family work, for both parents and children, in the treatment of parental mental illness. However, there has been only limited research on the implementation of family work in settings outside the mental health sector, such as family therapy or family counselling services, where mental illness may not be the primary presenting issue for a family. This article reports on a qualitative study that explored the experiences of family therapists working with families affected by parental mental illness. The article focuses on dilemmas clinicians faced integrating discussions about parental mental illness into family sessions. The findings support the need for clinicians to have appropriate training in family work related to mental health issues and also to develop the skill set needed to actively introduce, negotiate and explore the topic of mental illness with families.Practitioners points Developing knowledge, language and confidence in talking about mental illness may assist clinicians to raise discussions about parental mental illness in family sessions. Training in evidence‐based interventions for working with children of parents with a mental illness may provide a tool for clinicians in family sessions. Clinicians must be attuned to the ‘emotional readiness’ of parents and children to discuss parental mental illness. Developing readiness may take time.

Do private practitioners provide quality care to adolescents with substance abuse disorders?

s / Drug and Alcohol Dependence 156 (2015) e102–e182 e151 Preliminary analyses show significant group by visit interactions for breath CO (p=0.006) and urinary cotinine (p=0.03), with lower CO and cotinine levels in the Incentive vs. Control group. Final biochemical and abstinence data will be available for presentation at the June 2015 meeting, as will additional measures of nicotine withdrawal, craving, and respiratory symptomatology. Conclusions: These results suggest that an incentive-based intervention may be feasible and effective in producing initial smoking abstinence in this hard-to-treat sample of smokers.Financial support: T32 DA007242, P20 GM103644. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.410 Trauma exacerbates the effect of genetic variants in the dopamine system on cannabis use Jacquelyn L. Meyers1, Monica Uddin2, Sandro Galea1, Allison Aiello3, Derek Wildman2, Karestan C. Koenen1 1 Epidemiology, Columbia University, New York, NY, United States 2 University of Champagne-Urbana, Urbana, IL, United States 3 University of North Carolina Chapel Hill, Chapel Hill, NC, United States Aims: Although cannabis use is heritable, few studies have examined genetic risk for cannabis use alone, and of the studies that have been published, few genetic risk variants have been identified. In addition, the evidence for gene–environment interactions (GxE) in substance use behaviors is growing, with several GxE studies indicating that the effects of specific genetic variants are exacerbated by traumatic experiences. However, there have been no published GxE studies for cannabis involvement to date. Several biological systems that potentially incur risk for cannabis involvement have been identified via neurobiological studies, including variation in the dopaminergic system. For example, Volkow and colleagues investigated the effects of chronic cannabis use on the human brain using PET imaging, and found that cannabis abusers showed markedly blunted responses when challenged with methylphenidate, a drug that elevates dopamine. Methods: In this study, we provide evidence of association between sets of genetic variants in the dopamine system (96 single nucleotide polymorphisms across DRD1–DRD4) and frequency of cannabis use (days/month, within the past 30 days) in two independent majority African-American population based samples (Detroit Neighborhood Health Study, n=788; Grady Trauma Project, n=3752; p 33% treating prescription stimulants and prescription depressants, and ∼50% treating alcohol and marijuana. Over 50% referred youth to specialty care if use includedheroinormethamphetamine. The use of standardized assessments was rare and only ∼33% reported use of motivational interventions. Cognitive behavioral therapy was the predominate treatment delivered in individual youth sessions (85%); 75% provided family sessions but 90% of cases, it is critical that PPs be included in our effort to improve adolescent treatment quality.Financial support: P50-DA027841. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.412 Trends in use of and attitudes toward marijuana among youth before and after decriminalization: The case of California 2007–2013 Richard Miech, Lloyd A. Johnston, Patrick O’Malley, Jerald Bachman, John Schulenberg, Megan Patrick University of Michigan, Ann Arbor, MI, United States Aims: This analysis examines decriminalization as a risk factor for future increases in youthmarijuana acceptance and use. Specifically, we examine marijuana-related behaviors and attitudes of 8th, 10th, and 12th graders in California as compared to other U.S. states during the years before and after California passed legislation in 2010 to decriminalize marijuana. Methods: Data come from the annual Monitoring the Future study, which since 1975 has used questionnaires administered in classrooms to survey nationally representative samples of

Trauma exacerbates the effect of genetic variants in the dopamine system on cannabis use

s / Drug and Alcohol Dependence 156 (2015) e102–e182 e151 Preliminary analyses show significant group by visit interactions for breath CO (p=0.006) and urinary cotinine (p=0.03), with lower CO and cotinine levels in the Incentive vs. Control group. Final biochemical and abstinence data will be available for presentation at the June 2015 meeting, as will additional measures of nicotine withdrawal, craving, and respiratory symptomatology. Conclusions: These results suggest that an incentive-based intervention may be feasible and effective in producing initial smoking abstinence in this hard-to-treat sample of smokers.Financial support: T32 DA007242, P20 GM103644. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.410 Trauma exacerbates the effect of genetic variants in the dopamine system on cannabis use Jacquelyn L. Meyers1, Monica Uddin2, Sandro Galea1, Allison Aiello3, Derek Wildman2, Karestan C. Koenen1 1 Epidemiology, Columbia University, New York, NY, United States 2 University of Champagne-Urbana, Urbana, IL, United States 3 University of North Carolina Chapel Hill, Chapel Hill, NC, United States Aims: Although cannabis use is heritable, few studies have examined genetic risk for cannabis use alone, and of the studies that have been published, few genetic risk variants have been identified. In addition, the evidence for gene–environment interactions (GxE) in substance use behaviors is growing, with several GxE studies indicating that the effects of specific genetic variants are exacerbated by traumatic experiences. However, there have been no published GxE studies for cannabis involvement to date. Several biological systems that potentially incur risk for cannabis involvement have been identified via neurobiological studies, including variation in the dopaminergic system. For example, Volkow and colleagues investigated the effects of chronic cannabis use on the human brain using PET imaging, and found that cannabis abusers showed markedly blunted responses when challenged with methylphenidate, a drug that elevates dopamine. Methods: In this study, we provide evidence of association between sets of genetic variants in the dopamine system (96 single nucleotide polymorphisms across DRD1–DRD4) and frequency of cannabis use (days/month, within the past 30 days) in two independent majority African-American population based samples (Detroit Neighborhood Health Study, n=788; Grady Trauma Project, n=3752; p 33% treating prescription stimulants and prescription depressants, and ∼50% treating alcohol and marijuana. Over 50% referred youth to specialty care if use includedheroinormethamphetamine. The use of standardized assessments was rare and only ∼33% reported use of motivational interventions. Cognitive behavioral therapy was the predominate treatment delivered in individual youth sessions (85%); 75% provided family sessions but 90% of cases, it is critical that PPs be included in our effort to improve adolescent treatment quality.Financial support: P50-DA027841. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.412 Trends in use of and attitudes toward marijuana among youth before and after decriminalization: The case of California 2007–2013 Richard Miech, Lloyd A. Johnston, Patrick O’Malley, Jerald Bachman, John Schulenberg, Megan Patrick University of Michigan, Ann Arbor, MI, United States Aims: This analysis examines decriminalization as a risk factor for future increases in youthmarijuana acceptance and use. Specifically, we examine marijuana-related behaviors and attitudes of 8th, 10th, and 12th graders in California as compared to other U.S. states during the years before and after California passed legislation in 2010 to decriminalize marijuana. Methods: Data come from the annual Monitoring the Future study, which since 1975 has used questionnaires administered in classrooms to survey nationally representative samples of

Positive systemic practice: a controlled trial of family therapy for adolescent emotional and behavioural problems inIreland

This study aimed to evaluate the effectiveness of positive systemic practice (PSP) in the context of a controlled trial.PSPis a model of family therapy for adolescent emotional and behavioural problems. A series of thirty‐seven consecutive patients assigned to aPSPtreatment group and thirty‐five similar patients consecutively assigned to a waiting‐list control group completed this trial. They were assessed at baseline (Time 1) and 16 weeks later (Time 2) using the strengths and difficulties questionnaire (SDQ) that evaluates adolescent emotional and behavioural problems, and the systemic clinical outcomes and routine evaluation (SCORE) that evaluates family functioning. ThePSPgroup was also followed up 6 months later (Time 3). For trial completers, the clinical improvement rate on theSDQin the treatment group (65%) was significantly greater than that of the control group (20%) at Time 2 and the improvement was maintained at Time 3 (60%). The amelioration in adolescent behaviour problems on theSDQwas correlated with improvement in family adjustment on theSCORE. Treatment completers reported a high level of treatment satisfaction with this model of family therapy.Practitioner pointsPSPis a promising model of family therapy for adolescent emotional and behavioural problems.A distinctive feature of the model is the provision, by a co‐therapy team, of conjoint family sessions and parallel series of sessions to adolescents and parents.The model is described in a treatment manual.

Training Graduate Students to Work With Children and Families

Previous studies revealed that an alarming number of family therapists exclude children from family therapy, largely because they lacked comfort with children and perceived that their training, especially in play therapy, was inadequate. Implementing findings from one earlier study, a child-focused course was designed to address these issues. This current study examined students’ perceptions of the efficacy of this course in developing their knowledge and skills to treat children individually and in family sessions. Following institutional review board approval, 43 out of the 44 students enrolled in the child course over five semesters agreed to participate. A qualitative content analysis was utilized to explore participants’ written responses to open-ended questions on a questionnaire administered in the last class. Four overall themes emerged from the data: (1) training, (2) skills, (3) impact of training, and (4) knowledge. Frequency counts revealed the three subthemes/topics with the most comments: (1) the benefits of hands-on training, (2) students plan to continue child-focused training, and (3) general comments about the training in play interventions. Many reported increased comfort with children, and that they were more likely to work with children. Students’ comments reflect a significant increase in their perceived ability to work effectively with children and families. The findings indicate that many students experienced personal growth and significant development of their child-related knowledge, skills, and use of play therapy techniques. Included are a description of the course, recommendations, and limitations of the study.

Early Intervention for Symptomatic Youth at Risk for Bipolar Disorder: A Randomized Trial of Family-Focused Therapy

Objective:Depression and brief periods of (hypo)mania are linked to an increased risk of progression to bipolar I or II disorder (BD) in children of bipolar parents. This randomized trial examined the effects of a 4-month family-focused therapy (FFT) program on the 1-year course of mood symptoms in youth at high familial risk for BD, and explored its comparative benefits among youth in families with high versus low expressed emotion (EE).Method:Participants were 40 youth (mean 12.3 ± 2.8 years, range 9–17) with BD not otherwise specified, major depressive disorder, or cyclothymic disorder who had a first-degree relative with BD I or II and active mood symptoms (Young Mania Rating Scale [YMRS] > 11 or Child Depression Rating Scale >29). Participants were randomly allocated to FFT–High Risk version (FFT-HR; 12 sessions of psychoeducation and training in communication and problem-solving skills) or an education control (EC; 1–2 family sessions).Results:Youth in FFT-HR had more rapid recovery from their initi...

Can We Play Too? Experiential Techniques for Family Therapists to Actively Include Children in Sessions

Family therapists are in a position to provide therapeutic support to each member of a family system. Many family therapists however can feel at a loss as to how to actively include children in a session ensuring they gain the full benefit of the therapeutic interaction. This article provides relevant information on the rationale for actively including children in family sessions and specific experiential child-friendly techniques for use in family therapy.

Supporting Child Victims of Sexual Abuse

Families who present for counseling to address child sexual abuse (CSA) benefit from interventions that are evidence-based and meet children’s developmental needs. Trauma-focused cognitive behavioral therapy (TF-CBT) is an empirically supported approach that is structured to include parents or caregivers in parent-only sessions and a family component. This article reviews the CSA literature as it relates to families, provides an overview of TF-CBT and the trauma narrative intervention, and discusses preparation for and implementation of the narrative family session which is illustrated by a case study.

Intervention to improve social and family support for caregivers of dependent patients: ICIAS study protocol

BackgroundDespite the existence of formal professional support services, informal support (mainly family members) continues to be the main source of eldercare, especially for those who are dependent or disabled. Professionals on the primary health care are the ideal choice to educate, provide psychological support, and help to mobilize social resources available to the informal caregiver.Controversy remains concerning the efficiency of multiple interventions, taking a holistic approach to both the patient and caregiver, and optimum utilization of the available community resources. .For this reason our goal is to assess whether an intervention designed to improve the social support for caregivers effectively decreases caregivers burden and improves their quality of life.Methods/designDesign: Controlled, multicentre, community intervention trial, with patients and their caregivers randomized to the intervention or control group according to their assigned Primary Health Care Team (PHCT).Study area: Primary Health Care network (9 PHCTs).Study participants: Primary informal caregivers of patients receiving home health care from participating PHCTs.Sample: Required sample size is 282 caregivers (141 from PHCTs randomized to the intervention group and 141 from PHCTs randomized to the control group.Intervention: a) PHCT professionals: standardized training to implement caregivers intervention. b) Caregivers: 1 individualized counselling session, 1 family session, and 4 educational group sessions conducted by participating PHCT professionals; in addition to usual home health care visits, periodic telephone follow-up contact and unlimited telephone support.Control: Caregivers and dependent patients: usual home health care, consisting of bimonthly scheduled visits, follow-up as needed, and additional attention upon request.Data analysisDependent variables: Caregiver burden (short-form Zarit test), caregivers’ social support (Medical Outcomes Study), and caregivers’ reported quality of life (SF-12)Independent variables: a) Caregiver: sociodemographic data, Goldberg Scale, Apgar family questionnaire, Holmes and Rahe Psychosocial Stress Scale, number of chronic diseases. b) Dependent patient: sociodemographic data, level of dependency (Barthel Index), cognitive impairment (Pfeiffer test).DiscussionIf the intervention intended to improve social and family support is effective in reducing the burden on primary informal caregivers of dependent patients, this model can be readily applied throughout usual PHCT clinical practice.Trial registrationClinical trials registrar: NCT02065427

(555) Psychological functioning improves during intensive interdisciplinary pediatric pain rehabilitation

Intensive interdisciplinary pediatric pain rehabilitation programs seek to return children and adolescents who are disabled by pain to normal physical, social, and academic functioning. Psychological outcomes represent an important domain of functioning for these teens as they tend to show high levels of catastrophizing, have increased depressive symptoms, and tend to make avoidance of pain a priority over the pursuit of other goals and values. However, no study has specifically investigated the longitudinal pattern of change in these variables over the course of intensive treatment. Adolescents in our interdisciplinary pediatric pain rehabilitation program engage in physical therapy and occupational therapy, and each week also participate in 4.5 hours of yoga, 1 hour of self-regulation training, 2-3 hours of individual and 2-3 hours of group behavioral health intervention, and one hour each of group-based music and art therapy. Parents also attend 2-3 hours per week of group behavioral health intervention and occasional individual family sessions. For this investigation of initial outcomes, 22 participants completed measures (PROMIS anxiety and depression, PRCQ-catastrophizing, Pain Acceptance Questionnaire for Adolescents, and VAS pain ratings) at program baseline, the end of each week, and 19 completed one-month follow-up. Statistically-significant improvements in depression, anxiety, catastrophizing, and pain acceptance (all p’s<.01), but not pain, were observed during the program. Self-reported pain improved significantly between the end of the program and follow-up (t=3.14, p<.01), and pain acceptance showed further improvement between program-end and follow-up (t=3.17, p=.001). Heirarchical linear modeling analysis supports consistent improvement in psychological variables across the program and follow-up (all p’s<.001). Data also suggest that psychological variables change prior to changes in pain. These results suggest that interdisciplinary pediatric pain rehabilitation leads to steady improvements in psychological factors relevant to adolescents’ return to normal activities, and that changes in psychological functioning precede changes in self-reported pain. Intensive interdisciplinary pediatric pain rehabilitation programs seek to return children and adolescents who are disabled by pain to normal physical, social, and academic functioning. Psychological outcomes represent an important domain of functioning for these teens as they tend to show high levels of catastrophizing, have increased depressive symptoms, and tend to make avoidance of pain a priority over the pursuit of other goals and values. However, no study has specifically investigated the longitudinal pattern of change in these variables over the course of intensive treatment. Adolescents in our interdisciplinary pediatric pain rehabilitation program engage in physical therapy and occupational therapy, and each week also participate in 4.5 hours of yoga, 1 hour of self-regulation training, 2-3 hours of individual and 2-3 hours of group behavioral health intervention, and one hour each of group-based music and art therapy. Parents also attend 2-3 hours per week of group behavioral health intervention and occasional individual family sessions. For this investigation of initial outcomes, 22 participants completed measures (PROMIS anxiety and depression, PRCQ-catastrophizing, Pain Acceptance Questionnaire for Adolescents, and VAS pain ratings) at program baseline, the end of each week, and 19 completed one-month follow-up. Statistically-significant improvements in depression, anxiety, catastrophizing, and pain acceptance (all p’s<.01), but not pain, were observed during the program. Self-reported pain improved significantly between the end of the program and follow-up (t=3.14, p<.01), and pain acceptance showed further improvement between program-end and follow-up (t=3.17, p=.001). Heirarchical linear modeling analysis supports consistent improvement in psychological variables across the program and follow-up (all p’s<.001). Data also suggest that psychological variables change prior to changes in pain. These results suggest that interdisciplinary pediatric pain rehabilitation leads to steady improvements in psychological factors relevant to adolescents’ return to normal activities, and that changes in psychological functioning precede changes in self-reported pain.

Negotiating therapeutic alliances with a family at impasse.

To bridge the science-practice gap, the APA Presidential Task Force endorsed the publication of evidence-based case studies, but to date, there have been few such investigations of conjoint family therapy. To fill this gap, we studied a successful case of treatment-as-usual in a community agency. Owing to the complexity of the working alliance in conjoint therapy, we examined how an experienced family therapist managed to develop and sustain multiple alliances over time with an estranged couple in crisis. The outcome data showed clinically meaningful changes as well as high satisfaction levels and notable declines in the target complaint discomfort levels of all family members. Alliance indicators showed that the therapist worked diligently over time to connect emotionally with each family member and to foster and maintain safety. Session impact scores showed consistently deep sessions but more variability in smoothness. By working toward the only shared treatment goal-to repair each parent's individual relationship with their very angry daughter-the therapist was able to reduce the effect of the marital estrangement on the child. At the end of the 10 contracted family sessions, the parents agreed to begin working on their relationship in couples therapy, which led shortly thereafter to a reconciliation.