Family Therapeutic Approach Research Articles

Comparing the effectiveness of Bowen's family-based approach and Minuchin’s structural family therapeutic approach on improving communication patterns and reducing marital conflicts in women suffering from emotional divorce

Aim: Emotional divorce as a social harm is the first step in the divorce process and indicates the severity of marital conflicts originating from numerous factors such as the malfunctioning of couples' communication patterns. Hence, the present study aimed at comparing the effectiveness of Bowen's family-based approach and Minuchin’s structural family therapeutic approach on improving communication patterns and reducing marital conflicts in women suffering from emotional divorce. Method: The quasi-experimental research method was based on pretest-posttest along with a control group. The population included all the women suffering from marital conflicts referring to the Central Welfare Organization of Isfahan in the first three months of the year 1399. After sifting through the subjects, 45 samples were selected by simple random sampling and were categorized into two experimental and control groups. The tools applied in the research were the scale of communication patterns and marital conflicts. The samples of the experimental group attended the Bowen's and Minuchin’s family therapeutic training programs, but the control group did not receive any particular training. Finally, the data were analyzed at two levels of descriptive statistics (the Mean and the Standard Deviation) and inferential statistics (the analysis of Covariance and the analysis of Variance with multivariable frequent measuring) using SPSS software. Results: Findings revealed that both Bowen's and Minuchin’s therapeutic approaches can be effective on communication patterns and marital conflicts. In addition, a significant difference was noticed between the effectiveness of the two experimental groups (Bowen’s and Minuchin’s) on communication patterns of women suffering from emotional divorce, and the comparison of means suggested that family and structural therapy of Minuchin performed better. And finally, no significant difference was noticed between the effectiveness of the two experimental groups (Bowen’s and Minuchin’s) on marital conflicts in women suffering from emotional divorce, and only after lessening relationship with relatives, the structural effectiveness of Minuchin's approach proved to be better. Conclusions: Therefore, Bowen’s and Minuchin’s therapeutic approaches can both be helpful in reducing the rate of marital conflicts and improving the communication patterns of women suffering from emotional divorce, and consequently, reducing emotional divorce and increasing marital adjustments.

Effectiveness of Family Therapy on Poor Communication and Family Relationship: An Intervention Study

Background: A structured way of communication can bring clarity of expression between family members which help to maintain the homeostasis in the family. Like communication, there are various other aspects in the family that affects the entire familial relationship, such as cohesion between the members, their way of handling conflict situation and level of expressiveness amongst them. Aim: To evaluate and intervene poor communication and familial relationship through providing family therapy. Methods and Materials: This was an intervention study with a pre-post experimental design. Fifteen families those who had attended the OPD of the Institute of Psychiatry, Kolkata were selected in this study following clear inclusion and exclusion criteria and through purposive sampling technique. After assessing with FCS and BFRS, eclectic family therapy as provided, followed by post-assessment in the same parameters. Descriptive statistics and Wilcoxon signed-rank test were used for statistical analysis. Results: The findings reveal that an eclectic family therapeutic approach significantly improved communication level and overall family relationship among the members of the families. Conclusion: The study highlights the impact of communication in a familial relationship in the form of cohesion, expressiveness and conflict resolution through a practical implication of family therapy, which demonstrated to be highly effective.

Fibromyalgia in Women across the Lifespan: A Family Feminist Therapy Approach

ABSTRACT Fibromyalgia is a disorder that largely impacts females of all ages, yet there is limited treatment and research available, particularly related to family therapy. Fibromyalgia impacts family functioning, communication, and connectedness. Feminist family therapy offers a lens with which to address the myriad of concerns that a family faces, in a manner that empowers and validates the lived experiences of the client with fibromyalgia and their family. Mental health counselors can incorporate developmental context alongside feminist family therapeutic approach to assist women and their families to develop coping strategies, advocacy skills, and life meaning given the potential limitations that coincide with fibromyalgia.

Minding the adolescent in family-based inpatient treatment for anorexia nervosa: a qualitative study of former inpatients\u2019 views on treatment collaboration and staff behaviors

BackgroundFor some young persons diagnosed with anorexia nervosa, treatment will inevitably involve phases where hospitalization is required. Inspired by the encouraging evidence-base for outpatient family-based treatment for adolescent anorexia nervosa, clinicians and program developers have started to incorporate outpatient family-based treatment principles into higher levels of care. During family-based inpatient treatment, collaborative efforts are largely directed toward the parents of the adolescent. Consequently, the therapeutic focus on the young person is more of an indirect one. With this study we aimed to understand how young persons with lived experience from a family-based inpatient treatment setting, where the adolescents were admitted together with their parents, viewed therapeutic aspects related to staff-patient collaboration and staff-related behaviors.MethodsThirty-seven semi-structured interviews of former adolescent inpatients were conducted. Participants’ post-treatment reflections were inductively analyzed by applying a thematic analytic framework.ResultsBased upon user perspectives from a treatment setting highly influenced by a family therapeutic approach, findings revealed that former inpatients prefer tailored treatment and a collaborative approach. Eight subthemes constituting two main themes emerged: 1) There are no ready-made solutions. Staff should facilitate collaboration by tailoring treatment toward the young person’s perspectives, and 2) Emphasizing skills that matter. Staff should display a non-judgmental stance, educate patients, stimulate motivation, enable activities and prevent iatrogenic effects during the stay.ConclusionsThis study adds valuable user perspectives to the ongoing work with adapting family-based frameworks into higher levels of care. Clinicians could benefit from viewing their practice from the standpoint of the young person’s post-treatment reflections. From their unique perspectives as having lived experience and hence, “insider knowledge” with a specific treatment situation, clinicians are reminded of the importance of being mindful on the young persons’ views.

The gambling disorder: family styles and cognitive dimensions.

In this study we present data from a research carried out on a population of people with gambling disorder (GD). This research investigated the representation of family styles for subjects with gambling disorder, using the Family Adaptability and Cohesion Evaluation Scale (FACES-IV), their cognitive distortions through Gambling Related Cognitions Scale (GRCS-I), and the relation between these two dimensions. People with GD represent families with emotional detachment, while in the area of management of relational rules and roles, they reveal a perception of disorganization. Concerning their cognitive bias, GD people show the illusion of being able to control and predict the winnings and the perception of being unable to quit playing. Overall, these data provide specific directions for both the prevention and the therapeutic treatment of GD, highlighting the importance of a family therapeutic approach for the prevention of cognitive distortions.

Helping adolescents just say no to drugs: a multidimensional family therapeutic approach.

After participating in this educational activity, the psychiatrist should be better able to 1. Evaluate patients using the theory of Multidimensional Family Therapy (MDFT). 2. Treat adolescents with substance abuse problems using the three stages of MDFT. 3. Identify the limitations of MDFT. Multidimensional Family Therapy (MDFT) is reviewed, both in theory and as an evidence-based approach to treating adolescent substance abuse and related risk factors. The primary objectives of MDFT are to improve functioning in the four domains that centrally influence the course of adolescent development-the adolescent himself or herself, the parents, family interactions, and extrafamilial relationships. In MDFT, functioning in each domain is conceptualized as a risk or protective factor for problematic adolescent behavior and overall development; adolescent substance abuse is thus understood as a deviation from healthy, adaptive development and as indicative of impaired family systemic functioning. Improved functioning in the four domains is expected to place adolescents on healthier developmental trajectories, which decreases risk for substance abuse. Previous reviews of treatment approaches for adolescent substance abuse have surveyed multiple models. Previous articles specifically on MDFT have addressed a defined range of issues-whether theory, technique, or research. This review comprehensively synthesizes MDFT in theory, research, and practice, and suggests directions for future research.

Taking the Bull by the Horns: A Family Therapy Case of an East Indian Adolescent Substance Abuser

The cultural clash between traditional East Indian cultural values and US values often leads to parent–child conflicts, which increases East Indian adolescents’ risk for substance abuse. This is demonstrated in theory and through a case presentation of an East Indian adolescent substance abuser who was treated through an approach that coincided with the core principles of multi-dimensional family therapy. Family therapy interventions that coincided with East Indian cultural values were generally effective and resulted in decreased parental substance abuse, decreased family conflict, and improved parenting skills. Family therapy interventions that conflicted with East Indian cultural values were not effective. Further study is needed to ascertain the extent of parental and adolescent substance abuse in East Indian immigrant families and the effectiveness of a multi-dimensional family therapeutic approach to treatment.

Are children's voices heard when dealing with child safeguarding concerns? Audit of clinical records in a CAMH service in one district: Abstract G127(P) Table 1

Background Good practice around child safeguarding involves taking children9s views into account alongside a whole family approach. However there is little evidence of how often this directive is followed in clinical practice. A review of case notes in a CAMH service (part of inter-agency audit under section 11 (WT) requirements) addressed this issue recently. Aims To ascertain: a) Whether children9s views were taken into consideration when dealing with safeguarding concerns; b) Whether a ‘whole-family approach’ was adopted around safeguarding issues. Methods Retrospective audit of clinical records by two named safeguarding professionals in the borough. 96 case notes, representing 10% of cases open to the service, were reviewed. In 36 notes (37.5%) safeguarding concerns were recorded; these were reviewed in detail. Each set of records was assessed using a traffic light system. Red (unacceptable standard of practice), Amber (acceptable practice, nearing standards). Green (practice met or exceeded standards). Results Overall, service was rated amber for both questions. Other interesting observations: ▶Lack of narrative records. ▶Difficult to locate sections in the notes regarding safeguarding concerns, referral and subsequent actions. ▶Practice rated as ‘red’ did not lead to serious risks due to protective mechanisms - supervision and MDT discussions. Conclusions ▶There was little recording of the children9s voice in the notes; ▶Strong emphasis on parent9s / carers9 views. ▶Whole family therapeutic approaches are a core part of CAMHS work but this was not seen to be applied to safeguarding issues. Recommendations ▶Safeguarding referrals and notes should be recorded in a separate, colour-coded section of case notes. ▶Encourage practice of consciously recording children9s views separate from parents9. Encourage reflective practice and discerning application of knowledge around safeguarding ▶Use family therapy approaches to deal with safeguarding concerns. ▶Implement identified training needs. ▶Share and cascade good practice in monthly meetings with named and designated leads. ▶Re-audit.

Familientherapie bei Enkopresis

Encopresis is a taboo symptom, which is connected with great suffering from mental pressure not only for the children concerned, but also their relatives. Family related approaches are indispensable to understand encopresis, because as a result of high symptom persistence and psychological comorbidity in many cases a purely behavior-therapeutic, symptom focused approach is not sufficient, and further psychotherapeutic interventions are necessary. There is a strong temporal correlation between family interaction and frequency of soiling and changes of interaction influence changes in soiling more than the other way round. In a literature review different family relationship patterns and approaches of family therapy are represented regarding encopresis. Meaningful differences for family therapy are represented regarding primary/secondary encopresis, encopresis with/without comorbid psychiatric disorder as well as encopresis with/without dysfunctional family interaction. Distinctions are made between symptom focused, not-symptom focused and combined family therapeutic approaches, which are illustrated with case examples of outpatient and inpatient treatment. Symptom focused family therapy like e.g. externalizing of the soiling is helpful also if no dysfunctional family interaction patterns are present, because all family members can contribute to treatment success according to their own resources.

Genetic and environmental influences on Anxious/Depression during childhood: a study from the Netherlands Twin Register

For a large sample of twin pairs from the Netherlands Twins Register who were recruited at birth and followed through childhood, we obtained parental ratings of Anxious/Depression (A/D). Maternal ratings were obtained at ages 3 years (for 9025 twin pairs), 5 years (9222 pairs), 7 years (7331 pairs), 10 years (4430 pairs) and 12 years (2363 pairs). For 60-90% of the pairs, father ratings were also available. Multivariate genetic models were used to test for rater-independent and rater-specific assessments of A/D and to determine the genetic and environmental influences on individual differences in A/D at different ages. At all ages, monozygotic twins resembled each other more closely for A/D than dizygotic twins, implying genetic influences on variation in A/D. Opposite sex twin pairs resembled each other to same extent as same-sex dizygotic twins, suggesting that the same genes are expressed in boys and girls. Heritability estimates for rater-independent A/D were high in 3-year olds (76%) and decreased in size as children grew up [60% at age 5, 67% at age 7, 53% at age 10 (60% in boys) and 48% at age 12 years]. The decrease in genetic influences was accompanied by an increase in the influence of the shared family environment [absent at ages 3 and 7, 16% at age 5, 20% at age 10 (5% in boys) and 18% at age 12 years]. The agreement between parental A/D ratings was between 0.5 and 0.7, with somewhat higher correlations for the youngest group. Disagreement in ratings between the parents was not merely the result of unreliability or rater bias. Both the parents provided unique information from their own perspective on the behavior of their children. Significant influences of genetic and shared environmental factors were found for the unique parental views. At all ages, the contribution of shared environmental factors to variation in rater-specific views was higher for father ratings. Also, at all ages except age 12, the heritability estimates for the rater-specific phenotype were higher for mother ratings (59% at age 3 and decreasing to 27% at age 12 years) than for father ratings (between 14 and 29%). Differences between children, even as young as 3 years, in A/D are to a large extent due to genetic differences. As children grow up, the variation in A/D is due in equal parts to genetic and environmental influences. Anxious/Depression, unlike many other common childhood psychopathologies, is influenced by the shared family environment. These findings may provide support for why certain family therapeutic approaches are effective in the A/D spectrum of illnesses.

Relevance of family therapy in the psychiatric health care system

For 25 years, Norwegian psychiatric residents have been taught and supervised in individual psychodynamic psychotherapy. To some extent this has excluded the patients' most important interpersonal context from therapeutic interventions, namely the patient's family. Family therapy itself has in the same period developed and changed and is no longer considered an alternative. It has become far more modest in its aspirations and is today considered supplementary in a bio-psycho-social way of thinking. The well-documented effect of the psychoeducative method has shown that family therapy can be implemented in a traditional psychiatric setting. Today, the changed structure and patient population in the psychiatric health care system gives more opportunity for family therapeutic approaches. Psychiatric residents should learn to observe families and be trained in family-therapeutic interventions.Family Therapy, Resident Training.

Art therapy in transcultural family therapy

The increased existence of foreign culture patterns in the child population calls for transcultural comprehension in child psychiatry. This case report describes transcultural aspects in the therapy of an 11 year-old Moslem girl admitted to a child psychiatric department. Her symptoms were abdominal pain, headache, anxiety, and pretended fever. A family therapeutic approach was used together with elements of art therapy and individual therapy in a successful treatment. The family therapeutic approach was based on art therapy as a part of the communication where cultural symbols were an important part. An interpreter was not used. The cultural context where it is acceptable to overstep the borderline between reality and fantasy is seen as an important healing capacity.

Systemic Family Therapy in Adult Psychiatry a Review of 50 Families

The place of family therapy in adult clinical psychiatry remains unclear, despite considerable theoretical developments in the subject. In order to delineate the potential role of a family therapeutic approach, a study was conducted of the first 50 families treated in a newly established family-therapy clinical located in an adult psychiatric hospital.

Guidelines for the Family Therapeutic Approach to Eating Disorders

After a brief historical overview of the literature on family therapy in eating disorders, the authors' own clinical experience is summarized in some practical guidelines: give the family therapist a central position within the team, engage the family and/or spouse as co-therapist, explore the message of the eating disorder on different levels, neutralize the symptoms outside of the family interaction, promote direct communication, facilitate the separation-individuation process, and be available for a long time. Finally some special issues are discussed: sexual and/or physical abuse in the family, broken-home situations and single-parent families, married and chronic patients.

Annotation: Chronic pain and the family: a review*

In a paper entitled Why a Family Perspective of Pain? Turk, Rudy and Flor (1985), wrote that 'the first thing that struck us in thinking about the focus of this paper was how could anyone question the important role of the family when considering pain?' That question calls for two sets of answers. First, Chronic Pain Syndrome, as it is understood in the contemporary sense, is a relatively recent phenomenon. Second, family matters have rarely, if ever, assumed a central place in the management and treatment of medically ill patients. Considering the fact that as recently as 15 years ago, family literature on chronic pain was virtually non-existent, it is a source of considerable encouragement that at this point there is a sufficient body of literature on the subject to necessitate a review (Roy, 1982). Family issues in relation to chronic pain have been studied from four different perspectives: ( I ) role of family factors in the aetiology of chronic pain; ( 2 ) role of family members in the perpetuation of pain; (3 ) impact of chronic pain on the family; and (4) family therapeutic approaches to the treatment of chronic pain. The focus of this paper will be on the last issue. Rationale for family therapy for patients with chronic pain is derived from all of the three propositions mentioned above. There is limited evidence of the role of family dynamics in the aetiology of chronic pain (Violon, I 985). The part played by the family members, especially the spouse in the perpertuation of pain is well documented in the literature (Block, 1981; Kremer, Sieber and Atkinson, 1985). Impact of chronic pain on the overall functioning of the family in general and on the spouse in particular is another area that has received substantial attention over the past 10 years (Mohamed et al., 1978; Ahern and Follick, 1985; Rowat and Knafl, 1985; Flor, Turk and Scholz, 1987; Roy, 1987).

RUNAWAYS: JURISDICTION, DYNAMICS, AND TREATMENT

New research indicates more clearly than ever that running away from home is indeed a family affair. Understood as such, the implications for society's jurisdictional response and for effective treatment planning are deep and far‐reaching. The “status offender” legal jurisdiction over runaways needs to be changed and new alternatives for dealing with runaways and their families developed. The planning and implementation of these alternatives need to be informed with the perspectives of a family therapeutic approach sensitive to the intergenerational forces of loyalty, legacy, and trust operating within families.