Family Therapy Research Articles

Evolution of the roles of family physicians through collaboration with rehabilitation therapists in rural community hospitals: a grounded theory approach

BackgroundThe role of rural family physicians continues to evolve to accommodate the comprehensive care needs of aging societies. For older individuals in rural areas, rehabilitation is vital to ensure that they can continue to perform activities of daily living. In this population, a smooth discharge following periods of hospitalization is essential and requires management of multimorbidity, and rehabilitation therapists may require support from family physicians to achieve optimal outcomes. Therefore, this study aimed to investigate changes in the roles of rural family physicians in patient rehabilitation.MethodsAn ethnographic analysis was conducted with rural family physicians and rehabilitation therapists at a rural Japanese hospital. A constructivist grounded theory approach was applied as a qualitative research method. Data were collected from the participants via field notes and semi-structured interviews.ResultsUsing a grounded theory approach, the following three themes were developed regarding the establishment of effective interprofessional collaboration between family physicians and therapists in the rehabilitation of older patients in rural communities: 1) establishment of mutual understanding and the perception of psychological safety; 2) improvement of relationships between healthcare professionals and their patients; and 3) creation of new roles in rural family medicine to meet evolving needs.ConclusionEnsuring continual dialogue between family medicine and rehabilitation departments helped to establish understanding, enhance knowledge, and heighten mutual respect among healthcare workers, making the work more enjoyable. Continuous collaboration between departments also improved relationships between professionals and their patients, establishing trust in collaborative treatment paradigms and supporting patient-centered approaches to family medicine. Within this framework, understanding the capabilities of family physicians can lead to the establishment of new roles for them in rural hospitals. Family medicine plays a vital role in geriatric care in community hospitals, especially in rural primary care settings. The role of family medicine in hospitals should be investigated in other settings to improve geriatric care and promote mutual learning and improvement among healthcare professionals.

Behavioral skill practice as a predictor of mood and family functioning in adolescents with bipolar and depressive mood disorders: Results of a 6-month randomized trial of family-focused therapy.

Behavioral interventions require considerable practice of treatment skills in between therapy sessions. The effects of these treatments may vary with the degree to which patients are able to implement these practices. In offspring of parents with bipolar and major depressive disorders, we examined whether youth who frequently practiced communication and problem-solving skills between family-focused therapy (FFT) sessions had less severe mood symptoms and better psychosocial functioning over 6 months than youth who practiced less frequently. We randomly assigned offspring (ages 12-19) of parents with mood disorders to 12 sessions of FFT plus a mobile app that encouraged the practice of communication, problem-solving and mood management skills (FFT-MyCoachConnect [MCC] condition) or 12 sessions of FFT with an app that only allowed for tracking of symptoms and stress (FFT-Track condition). Independent evaluators assessed youths' mood and psychosocial functioning at 9-week intervals over 27 weeks. Clinicians rated participants' between-session skill practice at each FFT session. FFT-MCC was associated with more frequent skill practice than FFT-Track over 18 weeks of treatment. Skill practice was associated with reductions in youths' mood instability and perceptions of family conflict over 27 weeks in both app conditions. Skill practice mediated the effects of app condition on youths' mood instability and family functioning. Mobile applications as adjuncts to family therapy for youth with mood disorders can help increase skill practice. These findings provide preliminary causal evidence for behavioral skill practice improving mood symptoms and family functioning among youth with mood disorders.

Efficacy of Eating Disorder Focused Family Therapy for Adolescents With Anorexia Nervosa: A Systematic Review and Meta-Analysis.

To systematically review and evaluate the efficacy of eating disorder focused family therapy (FT-ED) in comparison to all other forms of psychotherapy for children and adolescents with anorexia nervosa. A secondary aim is to assess the relative efficacy of different variations of FT-ED (e.g., shorter vs. longer dose, parent-focused). A search with relevant terms was systematically conducted on four databases. Twenty-three publications across 18 randomized controlled trials met inclusion criteria. Outcomes of interest included variables related to weight, eating psychopathology, and remission status. Study quality was assessed, and data were extracted by two independent researchers. Adolescents receiving FT-ED gained significantly more weight by the end of treatment in comparison to those receiving individual psychotherapy. FT-ED that was delivered just to parents or to parents and child separately offered preferable weight outcomes and rates of recovery at the end of treatment in comparison to conjoint FT-ED. No other outcomes tested in the meta-analysis were statistically significant at the end of treatment or follow-up. Currently available data suggest the use of FT-ED in its conjoint or separated/parent focused format is the best outpatient treatment option for adolescents with anorexia nervosa when immediate weight gain is paramount. The variability of outcome measurement, including the tools used and timepoints chosen, limit comparison among no more than a handful of studies. The field would benefit from the standardization of measurement and reporting guidelines for future clinical trials. PROSPERO number: CRD42023396263.

Clinicians' experiences and perceptions of family therapy in the context of autism

AbstractThere is a paradoxical paradigm operating in neurodiverse families with autistic children, indicating increased stress alongside enrichment of family life. An emerging body of research has shown that the use of family therapy can improve family functioning and relationships in neurodiverse families. The current study uses constructivist grounded theory to explore clinicians' experiences and perceptions of utilising family therapy in the context of autism. Study findings suggest that clinicians integrate therapeutic techniques from diverse family therapy approaches to improve family relations by bridging different ways of learning and communicating as well as facilitating multiple perspectives. Integrating therapeutic techniques across diverse approaches further encompasses working with the systems around the individual with autism. To adapt family therapy in the context of autism, it is suggested that clinicians examine their own perspectives and beliefs about autism and keep a curious stance during the process.

Religiosity and the Marital Satisfaction of Malaysian Christians: A Pilot Study

Amid the challenges experienced by married couples and families, the need to examine the factors associated with marital satisfaction is recognised across various communities and backgrounds. Nevertheless, research on Malaysian Christians remains limited, especially concerning religiosity and marital satisfaction. Therefore, this study provides a deeper understanding of marital satisfaction among Malaysian Christians, focusing on its association with the factor of religiosity. 62 participants responded to self-report scales – including the Kansas Marital Satisfaction Scale and the Religious Commitment Inventory-10 – and open-ended questions on marital satisfaction experience and marital views, values, and attitudes development. A one-sample t-test analysed the marital satisfaction level of Malaysian Christians and some amount of marital distress was indicated. A hierarchical multiple regression analysis established that religiosity significantly predicted marital satisfaction. The open-ended responses were analysed thematically and the identified themes pertaining to how married Malaysian Christians experience marital satisfaction and religiosity complemented the quantitative findings. These findings could inform the development of programmes on marriage and family life and assist marriage counsellors, family therapists and other mental health professionals to work more effectively with the Malaysian community. Couples and families may also gain awareness, insights and inspiration towards enriching their experiences within marriage and family life.

Decolonially speaking, sensing, and thinking: Racialized tuition-based family therapists learning without teaching.

We address the ethical implications of training and becoming family therapists in the United States when considering the colonial control and management of knowledge by the westernized institutionalized university. We do so decolonially. Through the work of decolonial thinkers, doers, and sensers, we center our discussion on the heteropatriarchal Eurocentric institutionalization of knowledge linked to the development and sustainability of structures of family therapy training through racialization and monetization. We discuss a decolonial understanding of race in relation to the liberalized politics of diversity, equity, and inclusion and upward mobility of family therapy education. Most importantly, we reflect upon the possibilities of reexistence within family therapy, fissuring the colonial structures of training tuition-based family therapists. We locate those possibilities through practices of crack-making, epistemic insurgence, and mischief. Our discussions and reflections are developed throughout by thinking, sensing, and speaking decolonially, storying our racialized incarnated lives from the saberes, ज्ञान, rhythms, vapors, or tastes of our communities, displaced by the European cannon. We embrace a decolonial pedagogy of learning without teaching, positioning family therapy education as a site for sociopolitical struggle and action toward possibilities of reexistence.

Attachment-Based Family Therapy for Transgender Adolescent with Suicidal Thoughts: A Case Study

Aim: The aim of present study was the application of the Attachment-Based Family Therapy (ABFT) for a transgender adolescent with suicidal thoughts. Methods: Multiple baseline experimental single case study was used as the method of the present study. The population sample is a transgender adolescent (female to male) and his/her parent chosen according to the purposive sampling method. The adolescent completed The Suicidal Ideation Scale (SIS) over the course of the sessions. ABFT was implemented in twenty-seven 90 minute-sessions. Furthermore, visual inspection is applied to analyze and interpret data. Results: The results of this qualitative and step-by-step investigation of the attachment-based family therapy showed that this therapy was effective in significantly reducing the suicidal thoughts in the transgender adolescent. Conclusion: Effective intervention with transgender adolescents and their families can foster a secure attachment relationship. Family therapists may employ attachment-based family therapy to address suicidal tendencies among transgender individuals. This approach also supports families in navigating the transformative journey of their transgender child.

Fruits and vegetables dietary intake and its estimated consumption among adults receiving antiretroviral therapy in health facilities in Northcentral Ethiopia: a multi-facility cross-sectional study.

Despite the significant role of fruit and vegetables (FAVs) in preventing a variety of chronic diseases and their potential to bolster immune responses and slow the progression of HIV infection to AIDS, there is a lack of studies on the dietary intake of FAVs among HIV-infected adults in Africa, including Ethiopia. Hence, this study aimed to investigate the magnitude of FAV intake and estimated consumption among HIV-infected adults receiving antiretroviral therapy (ART) in northcentral Ethiopia. A multifacility cross-sectional study was conducted on the FAV intake among 865 HIV-infected adults receiving ART. A Poisson regression model with robust variance was used to identify factors associated with FAVs dietary intake. The study indicated that 655 (76.34%; 95% CI: 73.38, 79.07) HIV-infected adults reported consuming FAVs less than once per day, with 838 (97.67%, 95% CI: 96.41, 98.49) and 676 (78.79%, 95% CI: 75.92, 81.40) HIV-infected adults reporting consuming fruits and vegetables less than once per day, respectively. The median (IQR) total FAV intake was 271.3 (IQR: 92.5, 439.5) g/day, with the median (IQR) intake of fruits being 248.1 (IQR: 100.0, 400.0) g/day and vegetables being 273.78 (IQR: 82.44, 348.33) g/day, respectively. We found that being divorced (APR = 1.57, 95% CI: 1.16, 2.12), employed as a daily laborer (APR = 2.08, 95% CI: 1.36, 3.20), being employed (APR = 1.77, 95% CI: 1.10, 2.84), merchants (APR = 1.59, 95% CI: 1.03, 2.47), having children as caregivers (APR = 1.61, 95% CI: 1.02, 2.55), an advanced WHO clinical stage (APR = 1.32, 95% CI: 1.32(1.03, 1.69), and receiving ART for more than 8 years (APR = 1.78, 95% CI: 1.18, 2.67) were found to be independent predictors of FAV dietary intake among HIV-infected adults. From the findings, we understood that farmers were less likely to consume FAVs compared to employed individuals, daily laborers, and merchants. The finding indicated a very low level of FAV dietary intake among HIV-infected adults receiving ART, falling well-below the minimum recommendation for physically active adults. Despite living in areas with surplus production and producing these items, farmers are less likely to consume FAV. The study emphasizes the importance of focusing on the early stage of ART treatment for patients and family therapy, including counseling and guidance on consuming healthy diets such as FAVs, to enhance the role of children as caregivers for their families. Additionally, there is a need for comprehensive nutritional counseling to improve FAV consumption, with a particular emphasis on educating individuals about portion size estimation for the consumption of FAVs.

Clinical Intervention Strategies and Family Dynamics in Adolescent Eating Disorders: A Scoping Review for Enhancing Early Detection and Outcomes.

Background: This systematic review investigated the impact of familial factors on individuals aged 10-17 who have clinical signs or symptoms of eating disorders. Simultaneously, it scrutinized the involvement of the family in therapy, as well as other forms of intervention. Methods: The PsycINFO, PubMed, and Scopus databases were used to search for research material comprehensively. After applying specific criteria, 46 articles were deemed suitable and included in the systematic review. The study comprised a cohort of 4794 adolescents who received a diagnosis of either Anorexia Nervosa (AN), Bulimia Nervosa (BN), or Binge-Eating Disorder (BED). In addition, controls were utilized for 1187 adolescents, 1563 parents, 1809 siblings, and 11 other relatives. Results: The connection between family factors and eating disorders is primarily determined by the families' level of functioning, satisfaction with the family dynamic, parents' attitudes toward their children, and the role of food within the family system. Family Therapy was the most used psychotherapeutic approach in the treatment of AN. The incidence of reports in BN closely paralleled that of Cognitive-Behavioral Therapy (CBT) models. Articles about (Enhanced) CBT were exclusively associated with BED. Conclusions: Family-based approaches are crucial in comprehending, preventing, and addressing eating disorders in adolescents. Incorporating the study of family dynamics and actively engaging families in the treatment process can significantly enhance recovery rates and decrease the occurrence of relapses.

Examining the Connection Between Attachment and Risk for Psychopathology in Adolescents : A Comprehensive Review

The foundation of attachment theory is the notion that early relationships – such as the one between a child and primary caregiver – play a crucial role in patterns of emotional regulation, interpersonal behaviors and adult functioning. This review explores how attachment styles are associated with psychopathology in adolescents by systematically assessing research studies up to May 2024. Studies have shown that insecure attachment styles are risk factors for adaptation and psychopathology in adolescence, including anxiety disorders, dissociative disorders, borderline personality disorder, conduct disorder and substance use. Securely attached adolescents have better mental health outcomes. Longitudinal studies have also confirmed that early attachment affects later psychopathology. Insecure infant attachment is linked to depression, suicidality, substance use and dissociation in adolescents. Emerging attachment-based interventions – including, for example, Attachment-Based Family Therapy (ABFT) – have demonstrated promise in treating adolescent mental health by targeting attachment disorganization level. Ultimately, working on reflective functioning, parental sensitivity and emotion regulation skills can help adolescents repair their attachments. Even in light of these findings, attachment does not appear as straightforwardly explanatory as one might expect, given the developmental importance of attachment entering a new stage. Attachment researchers should consider participants’ experiences of early attachment, in light of patterns of change during individual development, as well as in light of a family systems perspective – for instance, understanding that some adolescents who become disaffected from their families have parents who tend to be dismissive of their emotional needs. All of these could help in effective prevention and treatment of adolescent psychopathology.

Emotional Dysregulation in Anorexia Nervosa: Scoping Review of Psychological Treatments.

Eating disorders are complex psychiatric disorders characterized by compensatory and restrictive behavior and a preoccupation with one's body. Eating and purging behaviors are considered dysfunctional emotional regulation strategies. Therefore, psychological treatment is essential. The most common psychological interventions are dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), family therapy (FBT), multi-family group therapy (MFTG) and mentalization-based treatment (MBT). The aim of this study was to summarize the current evidence on the impact of psychological treatments on emotional regulation difficulties and psychological symptoms in patients with eating disorders, especially anorexia nervosa. A search was conducted on PubMed and Web of Science using the terms "anorexia nervosa" and "emotion dysregulation". Of the 278 initial articles, we included 15 publications. The results indicate that the acquisition of coping strategies, through DBT, leads to an improvement in anxiety and alexithymia. DBT, CBT and MBT lead to a reduction in the use of dysfunctional emotional regulation strategies too. Eating disorders involve both physical and mental health; therefore, it is desirable for future research to focus on the mutual synergy between the mental and physical components by evaluating various factors, such as biomarkers and the most appropriate therapeutic approach, with respect to the treatment setting.

Family therapy and the ecology of parallel universes

AbstractAstrophysicists and cosmologists seriously propose that our universe, with its three dimensions and local physical bylaws, is one of an infinite number of parallel universes. This paper discusses the relevance of these ideas for contemporary systemic family therapy, such as thinking about the therapist's positioning in relation to the family. Ideas such as the anthropic principle suggest each meeting of a therapist and family forms a unique systemic entity or singularity with its own universe of by‐laws peculiar to a location in time and space. We are like travellers between parallel family therapy universes where the therapist's epistemology, theory or model is less important than how therapists and clients position themselves towards each other. This ecological positioning encompasses contextual, emotional, cultural, ethical and spiritual belief systems.

Family Therapy for Kosovar Mothers Who Experienced Conflict-Related Sexual Violence and Their Children in Postwar Times: A Pilot Randomised Waitlist-Controlled Trial.

Women who have experienced conflict-related sexual violence report significant long-term effects, including posttraumatic stress disorder (PTSD), depression and relationship difficulties. Research has demonstrated that maternal trauma is associated with children's behavioural difficulties and challenges in family functioning, such as impaired communication and harsh parenting. This pilot study is aimed at evaluating the preliminary effectiveness of family therapy for Kosovar mothers who experienced conflict-related sexual violence in 1998-1999 and later developed PTSD and their children in improving family functioning and reducing behavioural difficulties in postwar times. Sixty-four mothers were randomised to an intervention group or a waitlist control group. Data was collected during a screening phase, at baseline before intervention initiation, after the intervention group completed family therapy and once the waitlist control group received the intervention. Generalised linear mixed models were used to analyse group differences in family functioning and children's behaviours over time. At follow-up, mothers in the intervention group reported improved family functioning. However, mothers in the waitlist control group reported significantly fewer behavioural difficulties than mothers in the intervention group before the control group had started family therapy. There was no significant interaction between group condition and time for child-rated family functioning. Overall, this pilot study suggests that family therapy could be effective in reducing the effects of intergenerational trauma related to PTSD and conflict-related sexual violence. Future research should evaluate the long-term effects of family therapy to assess if immediate effects were maintained.

COMPARISON OF PSYCHOTHERAPY APPROACHES IN ADOLESCENTS AND CHILDREN WITH ANOREXIA NERVOSA

INTRODUCTION: Anorexia nervosa (AN) is a serious eating disorder characterized by an intense fear of gaining weight and obsessive calorie restriction, often starting during adolescence. It can lead to severe somatic complications such as hormonal imbalances and heart arrhythmias. Treatment typically involves a multidimensional approach addressing somatic and psychological aspects, primarily relying on psychotherapy. Family support is crucial, providing emotional support, motivation, and of a healthy lifestyle maintenance. Individual or group therapy helps patients understand their behavior, change negative thoughts, and develop healthier coping strategies. Family therapy, often using Cognitive Behavioral Therapy (CBT) or Adolescent-Focused Therapy (AFT), is common. Treatment is prolonged and requires patient commitment and collaboration with a therapeutic team. MATERIALS AND METHODS: This review of studies is based on articles from PubMed and Google Scholar databases, focusing on eating disorders in adolescents, including treatment, psychotherapy, family-based therapy, and anorexia nervosa. RESULTS: Studies and guidelines indicate that family therapy is the preferred method for treating anorexia in children and adolescents, leading to significant improvements in body weight and eating disorder symptoms, with long-term positive effects. Behavioral therapy and AFT also yield promising results in adolescents. CONCLUSION: Further research is needed to tailor therapy to each patient, as there is limited research comparing the effectiveness of individual methods, especially in the long term, despite their widespread clinical use.

Divided we fall: Constructive dialoguing about our political differences within family therapy training.

Widespread political polarization throughout the United States is a threat to the time-honored democratic tradition of utilizing civil discussion and respectful debate to express divergent views and strive for common ground. The political differences that divide us now are so deep and rife with toxic emotion that they threaten to undermine our social well-being at both the micro and macro levels. While family therapists are trained to work with relational tensions and to help family members to constructively negotiate their differences, the severity of the hostility and resentment tied to divergent political orientations has made this work increasingly difficult to achieve. This article explores how family therapy training programs can help trainees deepen their capacity for constructive political dialoguing that includes learning how to effectively manage their reactivity to those whose values and views may be dramatically different from their own so that they can support clients in doing the same.

Structural Relationships between Attachment Styles and Marital Satisfaction with the Mediation of Loneliness

Introduction: Identifying related and influencing factors on marital satisfaction is of particular necessity and importance. It seems that attachment styles and loneliness are among the factors affecting marital satisfaction. Aim: The present study aimed to determine the structural relationships between attachment styles and marital satisfaction with the mediation of loneliness. Methods: The research method was descriptive-correlational and the statistical population of this study included all women and men who were referred to family counseling centers in Ilam City in 2019 with complaints of marital problems which 320 were selected by convenience sampling method. To collect data Adult Attachment Questionnaire by Simpson (1990), ENRICH Marital Satisfaction Scale (1993) and The University of California Loneliness Scale (1996) were used. The collected data were analyzed in SPSS .24 and Amos. 24. Results: In the present study, the results showed that loneliness and marital satisfaction had a negative and significant relationship (β=-.258, P=.001). Avoidant attachment (β=-.189, P=.001) and anxious attachment (β=-.138, P=.001) and marital satisfaction had a negative and significant relationship. Loneliness in the relationship between secure attachment (β=.149, P=.001), anxiety (β=-.043, P=.048) and avoidance (β=-.140, P=.001) and marital satisfaction had a mediating role. Conclusion: The results showed that loneliness mediates the relationship between secure, anxious and avoidant attachment and marital satisfaction. Therefore, it is suggested that couples and family therapists, in counseling and couple therapy, to increase marital satisfaction, should also pay attention to people's attachment styles manifestations and feelings of loneliness caused by it.

The ‘uncomfortable aunt’: Acts of resistance against NHS practices that contradict our values

AbstractThis study explores the experience of family therapists performing ‘everyday’ acts of resistance against practices within the National Health Service (NHS) that contradict their values. Interpretative phenomenological analysis (IPA) was used to analyse semi‐structured interviews with five family therapists working in the NHS. Themes explored include the influence of the self of the therapist on their motivation to resist, and the necessity of resisting to survive in the job and ensure families' marginalised voices are heard in the wider system. The tension in balancing competing needs in the system and the energy that resisting both gives and takes are described, as well as how others in the system influence the therapists' ability to resist. Resisting emerges as a critical role of the family therapist, as well as crucial for practitioners to work in a way coherent with their sense of self.

The structural model of marital satisfaction based on relational beliefs with the mediating role of cognitive emotion regulation in married women

Introduction: Inefficiency in the process of emotion regulation prevents the emergence of efficient behaviors and appropriate coping responses to the situation in marital relationships by the individual, which seems to be influenced by relational beliefs. Aim: The present study aimed to formulate a structural model of marital satisfaction based on relational beliefs with the mediating role of cognitive emotion regulation in married women. Methods: The current research was descriptive-correlation based on the method of structural equations and the statistical population of the present study consisted of all married women between the ages of 30 and 50 who were referred to counseling centers in Tehran in the first six months of 2022, among them 371 women were selected using the random clusters sampling method. The research tools included ENRICH Marital Satisfaction Scale, Relationship Belief Inventory, and Cognitive Emotion Regulation Questionnaire. For data analysis, Pearson's correlation method and structural equations were used with SPSS version 22 and AMOS version 24 software. Results: The results of the present study showed there is an indirect and significant relationship between relational beliefs and marital satisfaction with the mediation of positive emotional cognitive regulation (P=0.003, Z=-2.11). There is an indirect and significant relationship between relational beliefs and marital satisfaction with the mediation of negative emotional cognitive regulation (P=0.009, Z=-1.78). Conclusion: The results showed that marital satisfaction is predicted based on communication beliefs with the mediating role of cognitive emotion regulation in married women. It is suggested that couple therapists and family therapists pay attention to relational beliefs and cognitive emotion regulation strategies derived from them in counseling and couple therapy to increase marital satisfaction.

Exploring clinicians’ experience of using Behavioural Family Therapy within an older adult community mental health service

This service evaluation summarises the experience of staff offering Behavioural Family Therapy (BFT) in a community mental health setting for older people. Semi-structured interviews were conducted to gather staff views and a Template Analysis was used to summarise feedback. This evaluation indicates that BFT were seen as beneficial to Older Adults (OA) across a range of mental health problems and adaptations were needed to support this patient group and their families.

Development of a Family Therapist’s Countertransference Management Training Program and Verification of its Effectiveness

Development of a Family Therapist’s Countertransference Management Training Program and Verification of its Effectiveness