Systemic Family Therapy Research Articles

Becoming Depressed at Work: A Study of Worker Narratives

Depression at work has been the subject of a growing body of research. However, though increasing attention is being paid to more contextualized orientations to the phenomenon, little is known of the experience of the depressed worker as worker, rather than (just) as depressed patient. There are few empirical accounts of how the workplace itself is implicated in the processes of becoming depressed. This article discusses the findings of an in-depth narrative interview study of 20 workers diagnosed with depression. A Systemic Family Therapy interview framework was utilized, enabling a focus not merely on medical symptoms but also on the network of workplace relations within which workers had been embedded prior to diagnosis. Implications of the findings for the management of work-related depression are discussed.

Improving partnerships with families and carers in in‐patient mental health services for older people: a staff training programme and family liaison service

In spite of policies advocating the involvement of families in the care of mental health service users in the UK, there are few examples of initiatives to develop staff confidence and skills in partnership working. This article describes a whole team training initiative and family liaison service to promote family inclusive working on in‐patient wards for older people in Somerset, UK. A three‐day staff‐training programme is described and training outcomes are reported. Staff report a substantial increase in confidence and family meetings held. A pre‐and post‐ training case note audit shows increased consideration of the needs of families. To further increase face to face meetings with families a family liaison service has been established, whereby a staff member with systemic family therapy training joins ward staff to hold family meetings as part of the assessment/admission process. Evaluation of this service has shown it to be effective with positive feedback from families and staff.

Efficiency of psychological interventions with persons with intellectual disability

This work is an attempt to review the literature and identify the key findings about the forms of psychological work needed for persons suffering from intellectual disability (ID) regarding their availability and efficiency. Though frequency of mental disturbances among persons with ID is greater than among general population, psychological interventions are often beyond their reach. Scarce availability of treatments excluded them from the scope of researches and therefore ensued with very few findings based on the proofs of their efficiency. Historically speaking, problems of mental health of persons with ID, have so far been dealt with by the medications administering or by applying techniques of behavioral modification. The main obstacles in obtaining psychological treatment for persons with ID are negative attitudes, physical and financial barriers, and insufficient education of psychotherapists on intellectual disability. In this work, the main findings in regard to the outcomes of treatments of persons with ID upon applying behavioral therapies, individual and group psychodynamic therapies, cognitive-behavioral therapies, cognitive therapies, counseling and systemic family therapies are presented. The results indicate that the service of psychological work with persons with ID has yet to be improved.

Family work in geriatric psychiatry

Dementia and other late-life conditions in neuropsychiatry impose a heavy burden on society as a whole and in families in particular. A number of clinical presentations involving family aspects may be seen in clinical practice in a range of diagnoses (Alzheimer's disease, other dementias, depression or any other psychiatric disorder in the elderly). As a consequence, there is a growing trend towards working with families in geriatric psychiatry. Marital issues are not a frequent target for specific clinical intervention, but couple therapy may be useful regardless of age. The effectiveness of family systems therapy has not been widely evaluated in psychogeriatrics, so far. However, it may be a powerful resource when family dynamics must be addressed, mostly in families where dysfunctional circularities precede the outburst of severe clinical problems. More often, family psychoeducation will be the first indication, in different formats, settings and levels of intensity. However, context reading and systemically-informed work are not restricted to classical family therapy and do not imply it. Is has been suggested that family psychoeducation should sometimes include a stronger family systems perspective. Structured and feasible family assessments should always precede interventions. Indeed, they are a first step of the intervention itself, while necessarily reviewed through the course of family work. Ageism perhaps still influences to some extent health professionals' attitudes, including the ones of family therapists, leading to the underutilization of family approaches in the elderly. However, working with families remains a core process in geriatric psychiatry and family therapy may be a powerful resource in particular cases.

Systemisch-psychomotorische und gesprächsorientiertsystemische Beratung bei Familien mit psychisch gestörten Kindern

Systemic counselling and therapy are usually verbal interventions. However, communication on an abstract level often exceeds the capabilities of children up to about 12 years, leaving them less involved in the therapeutic process. In contrast, symbolic play has been shown to be an effective tool for psychological formulation and intervention. However, it has not been widely used so far in family therapy. In order to explore this hypothesis a form of systemic family therapy (SB; exclusively verbal) was compared with a new concept called systemic-psychomotor family counselling (PsyFam; based on symbolic play). We found good efficacy of PsyFam, reflected in an average effect size of d = .73 (SB: d = .53), even though statistical significance of the group effect could not be shown due to the small sample size. Systemic-psychomotoric family counselling is a promising new approach worth further research in controlled therapy studies.

Supervising Integrative Psychotherapy in the 21st Century: Pressing Needs, Impressing Possibilities

Supervisors and teachers who are interested in advancing integrative psychotherapy in the 21st century have the dual task of surveying the range of treatment approaches that have been developed and distilling these approaches down to a manageable number of influences that have been found to have the greatest impact on clinical practice over time. It has been proposed that there are four bona fide schools of psychotherapy that would be most useful for comprehensive training and supervision that would contribute to either (a) case conceptualization or (b) the process of clinical interviewing: psychodynamic psychotherapy; cognitive-behavioral psychotherapy; family systems therapy; and, humanistic/client-centered therapy. The goal for such broadly based clinical instruction would be for students, trainees, and interns to have an ability to provide a multi-level case conceptualization for any of the psychotherapy cases for which they are providing treatment. Thorough instruction in clinical reasoning and decision-making in this type of multi-level case formulation can provide some of the most valuable tools for novice and experienced clinicians alike.

‘What’s occurring’ in learning disability services? Piloting the Barry Systemic Consultation Clinic

We have recently established a consultation clinic within our multi-disciplinary teams using ideas and techniques drawn from systemic family therapy. In this article we discuss our experiences and reflect upon the process.

Learning and Living Systemic: Exploring the Personal Effects of Family Therapy Training

Despite growing recognition that systemic family therapists need to be adept at personal reflection and managing the therapeutic relationship, little research has explored the effects of training beyond the development of skills. This article provides a report on a qualitative study focussed on the personal effects of family therapy training, with particular reference to the aspects of training that foster personal reflection and growth. Twenty three trainees from three training institutions were interviewed, utilizing the practices of grounded theory. Trainees reported a deepening relational awareness, which applied to both personal and professional domains and included shifts in perspectives on relationships with loved ones. Five aspects of training were identified as responsible: (1) personally challenging experiences with clients; (2) supervisors who live the paradigm; (3) the demystification of theory; (4) a safe supervisory space; and (5) the development of trusting peer relationships. Interns also described, in turn, how their personal development affected their clinical work, particularly in the development of compassion and empathy. This study serves to highlight training practices that support reflective practice in systemic family therapy.

Reframing “Reframing”: Another Look at “Reframing” Inspired by a Sonnet by Charles Baudelaire

Even if rarely discussed in the current systemic literature, “reframing” remains a key concept and technique in systemic family therapy. With reference to Baudelaire's poem entitled “The Frame,” we attempt to highlight and revisit reframing attitudes and interventions in clinical practice with families.

Systemic psychotherapy as an intervention for post‐traumatic stress responses: an introduction, theoretical rationale and overview of developments in an emerging field of interest

The purpose of this article is to critically examine the literature to provide a rationale for including systemic family therapy (SFT) in the psycho‐social treatment of people suffering the impact of post‐traumatic stress (PTS). Attention is drawn to the relatively underdeveloped academic literature on PTS and the family. The impact of PTS is conceptualized within a psycho‐social framework and the current evidence base for psycho‐social interventions for PTS responses is described, highlighting the opportunity and need to undergird this area of daily practice. The impact of PTS on the family at multiple levels is identified, emphasizing its recursive nature. The case for SFT is articulated and a range of models of family intervention for PTS briefly reviewed, concluding with an emphasis on Walsh's key processes in family resilience as a framework for practice.

How to fail as a family therapist working with adults with learning disabilities: a paradoxical literature review

Over the past 15 years there has been a growing interest in the application of systemic family therapy approaches, methods and techniques to problems encountered by those living with learning disabilities and their social networks. As reports of success in this area increase, however, it is clear that this marginalized group of people continue to suffer from a lack of a ‘theory of failure’. In order to overcome this deficit, a review of the literature as at December 2010 forms the basis of such a paradoxical description, welcoming those living with learning disabilities into a family therapy tradition.

A Review of “Systemic Family Therapy: From Theory to Practice”

Graduate students studying family therapy are presented with the daunting challenge of familiarizing themselves with the wide range of approaches found in the literature as well as to decide upon s...

Frameworks for Practice in the Systemic Field: Part 2 — Contemporary Frameworks in Family Therapy

This is the second of two articles to map the landscape of practice theory in systemic family therapy. The first article gave a particular chronology of the development of family therapy practice theory, beginning with the frameworks that emerged in the 1960s‐1970s and then tracing the transitional decade of the 1980s. The convergences of three sets of influences — ecosystemic epistemology, the feminist challenge and postmodernist ideas — led to the changed landscape of post‐1990 practice theory. This second article picks up at this point, mapping four contemporary influential approaches in Australian family therapy — the Milan‐systemic, narrative and solution‐focused frameworks, and the dialogical perspective. Social constructionist and narrative ideas together constitute the dominant common theory influence in the post‐1990 practice frameworks, although intersected and used in different ways in the different frameworks. Throughout the history of the development of practice theory, context and relationship remain the enduring parameters of the systemic family therapy field.

The differentiation of self and the capacity to tolerate interpersonal difference and societal expectations: an exploratory study

Murray Bowen developed one of the most influential and long-standing family systems therapies: Multigenerational Family Therapy. His central theoretical construct is the ‘differentiation of self’. Differentiation is the capacity to establish and maintain a solid sense of self in the context of relationship pressures and emotional demands. While Bowen's theory has enjoyed popularity, it is only in more recent years that his central construct has been tested via the development of new inventories. Skowron and Friedlander based their Differentiation of Self Inventory on four factors; I-Position, Emotional Reactivity, Emotional Cut-off and Emotional Fusion. While these factors have served to give insight into the structure of the differentiation of self, questions remain as to whether they provide a full and sufficient representation of the complexity of this construct. The following investigation extends Skowron and Friedlander's research by investigating whether other factors form a fundamental part of the differentiation of self. Two new potential constructs were suggested by the study: one, the significance of an individual's capacity to tolerate interpersonal difference and, two, the importance of societal expectations on self differentiation, especially in collectivist cultures.

Christian Counseling for M. Div. Students throughout Diagnosing Bowen’s Family Systems Therapy

Christian Counseling for M. Div. Students throughout Diagnosing Bowen’s Family Systems Therapy

Challenges in conducting a multi‐site randomized clinical trial comparing treatments for adolescent anorexia nervosa

To describe obstacles in the implementation of a controlled treatment trial of adolescent anorexia nervosa (AN). The original aim was to enter 240 participants with AN to one of four cells: Behavioral family therapy (BFT) plus fluoxetine; BFT plus placebo; systems family therapy (SFT) plus fluoxetine; SFT plus placebo. Recruitment was delayed pending a satisfactory resolution concerning participant safety. After 6 months of recruitment it became clear that the medication was associated with poor recruitment leading to a study redesign resulting in a comparison of two types of family therapy with a projected sample size of 160. One site was unable to recruit and was replaced. Problems with the delineation of safety procedures, recruitment, re-design of the study, and replacement of a site, were the main elements resulting in a 1-year delay. Suggestions are made for overcoming such problems in future AN trials.

The Teenager’s Confession: Regulating Shame in Internal Family Systems Therapy

This case study explores the clinical relevance of the differences among shame, guilt that is linked with shame, and pure guilt. Empirical literature on emotion suggests that shame is instrumental in a host of psychiatric symptoms while pure guilt is prosocial and adaptive. Regulating shame and being able to feel pure guilt may be especially important for trauma patients like the one described here, who have transgressors as well as victims. The protocol of internal family systems (IFS), a mode of therapy that utilizes psychic multiplicity and actively recruits internal compassion, is described as a treatment for regulating shame and facilitating adaptive guilt.

Piloting behavioral family systems therapy to improve adherence among adolescents with HIV: A case series intervention study

Adolescents with HIV are at high risk for suboptimal adherence but have been ignored by the literature. Treatment outcome and feasibility data for the first-known adaptation of Behavioral Family Systems Therapy (BFST) targeting adherence among adolescents with HIV are presented for four adolescents with suboptimal adherence. The intervention was delivered in an alternating home-based and telehealth format and a multi-method adherence assessment approach was used. Adherence improved for three adolescents, viral load decreased for two adolescents, and barriers to adherence declined for all participants. Delivery of an adapted BFST intervention was acceptable to families and may be a promising treatment approach.

A Novel Approach to Hospital Palliative Care: An Expanded Role for Counselors

A large tertiary hospital in central Georgia has found a novel approach to hospital palliative care. It is unique in that the approach has a strong counseling base in providing the palliative service, rather than major reliance on advance practice nurses or palliative physicians. The Medical Center of Central Georgia employs master's prepared counselors who spend the hours needed to assist families in making difficult end-of-life decisions. Using a family systems therapy approach, these counselors have developed the Transitions and Palliative Care Therapy Model, which has proved to be a successful means of providing the services. The model includes the "7 Core Components of Communication and Decision Making," which gives the counselors actual interventions to use in working through these complex cases. The growth of the program over 7 years is staggering with the outcomes far exceeding even the predicted volume from the Center to Advance Palliative Care. The model has the counselor at the heart of the team, keeping the communication open and flowing. The Transitions and Palliative Care Therapy Model has become an accepted standard of practice at Medical Center of Central Georgia and continues to be a successful means of managing the most complex cases in the hospital.

Systemic Hypothesising for Challenging Behaviour in Intellectual Disabilities: A Reflecting Team Approach

The treatment of challenging behaviour in intellectual disabilities has evolved dramatically since the 1950s, from a reliance on psychopharmacological restraint and operant conditioning to a multifaceted support plan that recognises the communicative intent of the client alongside their need for meaningful community participation. In recent years there has also been an increasing recognition of the critical role of family relationships in the maintenance and amelioration of challenging behaviour, as well as in attempts to integrate the fields of family therapy and applied behaviour analysis. The aim of this article is to describe a model of tertiary consultation that draws on the skills of systemic family therapy to assist clinicians who might be struggling with responding to challenging behaviour in settings characterised by complex and ‘stuck’ mediation problems. This model applies principles of reflective practice to assist such clinicians to develop a sophisticated understanding of the nature of interactions and relationships in the client's life, a critical prerequisite to the application of behavioural intervention. A detailed description of the model and a case study will be provided.