Family Therapy Interventions Research Articles

Borderline Personality Disorder, Divorce and Family Therapy: The Need for Family Crisis Intervention Strategies

Recent literature reviews, point out the lack of crisis intervention and crisis prevention programs that are in existence to address crises experienced by first-degree and divorced family members of Borderline Personality Disorder (BPD) probands. The focus of such intervention programs should be to facilitate the improved ability of the first-degree and divorced family members to manage and transcend the unstable family environment. Correlations between personal instability and frequency of psychosocial crises have been examined, as well as the ripple effect of frequent individual crises on family environments. Reviews of current therapeutic interventions, as well as a synthesis of practical family therapy interventions focusing on breaking the cycle of dysfunctional multi-generational family environments are also examined.

Integrating family therapy in adolescent depression: an ethical stance

Adolescent depression, particularly where suicidal behaviour is involved, is a complex and pressing mental health problem and demanding for families, therapists and services alike. This article reviews the evidence‐based literature for adolescent depression including family therapy approaches. It suggests an integrative treatment approach that includes individual psychological treatment like CBT, medication where required and a family therapy intervention is supported by the literature. The focus of the latter is psychoeducation, building resilience and hope, enhancing communication, reducing relational conflict between parents and adolescents and addressing attachment and relationship issues. A systemic framework for integrating family therapy in the evidence‐ based treatment of adolescent depression is described. This is based on an ethic of hospitality towards different languages of therapy, which is illustrated by a detailed example from family therapy practice.

Distinguishing Maltreating versus Nonmaltreating At-Risk Families: Implications for Foster Care and Early Childhood Education Interventions

Discriminant function (DF) analysis was used to distinguish 92 ethnically and socioeconomically diverse maltreating versus nonmaltreating families on indicators of socioeconomic status (SES) and parenting stress. Families included those with substantiated reports of child maltreatment ( n = 23), plus Head Start families ( n = 36), and child care families ( n = 33) without reports of maltreatment. The significant SES distinguishers were poverty and parental education and employment. The significant parenting stress distinguishers were parental self-reports of a dysfunctional parent–child relationship and difficult child temperament. Maltreating and Head Start families were similar in terms of poverty, but only the maltreating families had clinical levels of parenting stress. Implications for family therapy and early childhood education interventions are discussed.

Applicability of Family Therapy for Chinese Children and Adolescents Suffering from Anorexia Nervosa in a Chinese Context: A Preliminary Study

ABSTRACT This article presents the results of a preliminary study that assesses the applicability of family therapy for Chinese adolescents suffering from anorexia nervosa in Hong Kong, an area that had never been studied in the past. A total of 27 Chinese emaciated children and adolescents received family therapy and conventional psychiatric treatment from the university-based family treatment center, in collaboration with the psychiatric unit of the university hospital. The treatment outcome was evaluated by changes in body weight, body mass index, symptoms associated with the disorder, level of psychological distress, marital quality of parents, and perceived family functioning at three different phases, namely, at the pretreatment phase, immediately upon the completion of treatment, and 6 months after treatment. The results of this study have shown that family therapy combined with conventional psychiatric treatment was effective in restoring body weight, increasing the body mass index, and recovering menstruation. Six months after treatment, patients were clinically no longer symptomatic in Drive for Thinness and Perfectionism; six psychological dimensions of the Symptoms Checklist-90 (R) have changed from a dysfunctional range to a functional range; and the fathers perceived significant improvement in dyadic consensus. However, changes of perceived family functioning 6 months after treatment were statistically insignificant, suggesting limitations of the assessment measure in capturing changes in this area.

The effectiveness of family therapy and systemic interventions for child‐focused problems

This review updates a similar paper published in the Journal of Family Therapy in 2001. It presents evidence from meta‐analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for sleep, feeding and attachment problems in infancy; child abuse and neglect; conduct problems (including childhood behavioural difficulties, ADHD, delinquency and drug abuse); emotional problems (including anxiety, depression, grief, bipolar disorder and suicidality); eating disorders (including anorexia, bulimia and obesity); and somatic problems (including enuresis, encopresis, recurrent abdominal pain, and poorly controlled asthma and diabetes).

The effectiveness of family therapy and systemic interventions for adult‐focused problems

This review updates a similar paper published in this Journal in 2000. It presents evidence from meta‐analyses, systematic literature reviews and controlled trials for the effectiveness of couples and family therapy for adults with various relationship and mental health problems. The evidence supports the effectiveness of systemic interventions, either alone or as part of multimodal programmes, for relationship distress, psychosexual problems, domestic violence, anxiety disorders, mood disorders, alcohol abuse, schizophrenia and adjustment to chronic physical illness.

Dyadic Developmental Psychotherapy: an evidence‐based treatment for children with complex trauma and disorders of attachment

ABSTRACTDyadic Developmental Psychotherapy (DDP) is a family therapy treatment based on Attachment Theory. It is an integration of several approaches, methods and techniques that have a strong evidence base. The approach was originally developed to treat children with disorders of attachment and has been shown to be effective. It has since been more broadly used to help families with a variety of difficulties, including complex trauma. This paper outlines the primary principles and components of DDP and the evidence to support the effectiveness of the components and, therefore, of DDP.

Integrative Module‐Based Family Therapy: Application and Training

The field of marriage and family therapy is currently at a crossroads. The challenge for contemporary therapists is how to incorporate the wisdom of previous models with the accountability that comes from evidence-based practice. The Integrative Module-Based Family Therapy treatment model provides a formalized series of steps that clinicians can use in their case planning and implementation. It is based on nine clinically relevant modules for assessment and intervention that are consistent with current best practices and empirically supported treatments. It thus meets the need for a structured family therapy practice and training approach that is respectful of the "art" of family therapy while still adhering to the principles of the "science" of evidence-based treatment.

WORKING WITH CHINESE FAMILIES IN ADOLESCENT DRUG TREATMENT

Whilst ample evidence shows that family therapy is effective in adolescent drug treatment, there is little effort in Hong Kong to involve family members in treating adolescent drug abuse systematically. Yet, ironically, the place of the family has always been highly regarded in Hong Kong. This paper explores the themes of adolescent drug abuse in Chinese families, as well as the process of applying family therapy in a Chinese context using the structural family therapy model as a guide. Nine Hong Kong Chinese families were involved in family therapy treatment and five themes were generated from session notes and videotape transcriptions by the investigator. It is suggested that family therapy can effect change in adolescent drug abuse through changing family interactions and improving family functioning in a Chinese context. However, the need to consider the different roles of parents in the Chinese family is one issue that warrants special attention.

Book Reviews: When Marriages Fail: Systemic Family Therapy Interventions and Issues, A Tribute to William C. Nichols (2006). Craig A. Everett and Robert E. Lee (Eds.), Binghamton, NY: Haworth, 310 pages, US$34.95. Reviewed by Mark L. Belas

Book Reviews: <i>When Marriages Fail: Systemic Family Therapy Interventions and Issues, A Tribute to William C. Nichols</i> (2006). Craig A. Everett and Robert E. Lee (Eds.), Binghamton, NY: Haworth, 310 pages, US$34.95. Reviewed by Mark L. Belas

Elder Abuse and Neglect in Latino Families: An Ecological and Culturally Relevant Theoretical Framework for Clinical Practice

There is a scarcity of theoretical frameworks capable of describing precursors and dynamics associated with elder abuse and neglect in Latino families. The present manuscript seeks to address this gap in the literature by presenting an integrative theoretical framework that fosters an ecological and cultural understanding of elder abuse and neglect among Latinos. The proposed model rests on the premise that Latino families caring for elder adults have the ability to adapt to the demands of aging only if they are supported by nurturing environments. The usefulness of the model is threefold. First, the proposed model describes elder abuse and neglect as multifactorial phenomena and identifies specific risk factors associated with the etiology and maintenance of elder abuse and neglect in Latino families. Second, the model provides clinical applications, including reflections about the therapists' need to extend their scope of practice beyond traditional family therapy interventions. A brief case study is presented that illustrates the clinical application of the model with a Latino family. Implications for future research are discussed.

Exploring the Role of Parental Monitoring of Peers on the Relationship Between Family Functioning and Delinquency in the Lives of African American and Hispanic Adolescents

This cross-sectional study explores potential mediating effects of parental monitoring of peers on three adolescent problem behaviors (externalizing behavior, drug use, sexual risk behavior) among juvenile delinquents and their families. Participants are 190 African American and Hispanic adolescents and parent guardians enrolled in a family therapy treatment efficacy study targeting delinquency. Parental monitoring of peers mediates the association between family functioning and externalizing behavior in the full sample. Comparable results are not found in post hoc analyses of each racial and ethnic sample or among drug use and sexual risk behaviors. Research and health service implications are discussed.

Linking Theory With Practice: Theory-Derived Interventions in Prevention and Family Therapy

This article shows how it is possible to progress from evaluations to direct interventions in prevention and family therapy. Models derived from a developmental relational theory of competence socialization in intimate relationships can be applied when evaluation is linked directly to specific intervention. The theory is linked to normative and nonnormative dimensions isomorphic with classifications from the Diagnostic and Statistical Manual of Mental Disorders—IV. In addition to verbally based interventions, nonverbal prescriptive tasks derived from models of the theory can also be administered as homework assignments. Self-help written workbooks or protocols derived from theoretical models can also be administered as alternative or additional structured interventions.

Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families.

Client engagement is an essential yet challenging ingredient in effective therapy. Engaged clients are more likely to bond with therapists and counselors, endorse treatment goals, participate to a greater degree, remain in treatment longer, and report higher levels of satisfaction. This study explored the process of engaging high-risk youth and their parents in a unique home-based family therapy intervention. Qualitative interviews were conducted with 19 families who completed family therapy sessions that included a core component aimed at increasing treatment engagement. Parents' and youths' perceptions of engagement suggest the importance of developing therapeutic alliance with therapists, who facilitated building a shared alliance among family members. Implications for improving client engagement are discussed within the context of alliance building with the therapist and among family members.

Culturally Competent Family Therapy with Latino/Anglo-American Adolescents: Facilitating Identity Formation

This paper focuses on culturally competent family therapy interventions focused on the topic of identity formation in Latino/Anglo American (L/AA) youth, a growing segment of the United States population. Given the overall scarcity of literature specific to this unique group, models of identity formation for a broader category (i.e., multi-racial youth) are presented and critiqued in terms of their application to L/AA adolescent. Special identity-related factors for L/AA youth populations are presented including the race of the youth's Latino parent, the L/AA youth's appearance, acceptance from family members and peers, and cultural conflict within the home. Guided by Sue and Sue (2003), specific suggestions for culturally competent family therapy are provided, and detailed using a case vignette.

The Forgotten Siblings

In this article I wish to argue that the qualities and dynamics of sibling relationships may have been overlooked in family therapy. In overlooking them, we have also overlooked a significant feature in the emotional life of children. I would like to suggest that sibling relationships are where children practise identity. In these relationships we can learn how to be one in a group. Family Therapy treatment may not make enough use of the dynamic of the sibling relationship.

Blueprints in Sweden. Symptom load in Swedish adolescents in studies of Functional Family Therapy (FFT), Multisystemic Therapy (MST) and Multidimensional Treatment Foster Care (MTFC)

The purpose of the present study was to compare symptom load in youth groups treated with three Swedish Blueprint programmes—Functional Family Therapy (FFT), Multisystemic Therapy (MST) and Multidimensional Treatment Foster Care (MTFC)—to see if symptom load matches the intensity of the treatment model as expected. These youth groups were also compared with in- and outpatients from child and adolescent psychiatry, and a normal comparison group. In addition, we compared the symptom load of their mothers. Symptom load was measured by the Achenbach System of Empirically Based Assessment (ASEBA) in the adolescents, and by the Symptom Checklist 90 in their mothers. The results showed that youth in the MST and MTFC studies had a higher symptom load than in the FFT study, and the same pattern of results was found in their mothers. It is concluded that there seems to be a reasonable correspondence between the offered resources and the symptom load among youth and parents; treatment methods with higher intensity have been offered to youth with higher symptom load. The correlation between internalized and externalized symptoms was high in all study groups. The MST and MTFC groups had an equally high total symptom load as the psychiatric inpatient sample.

Unbalancing the Effects of Chronic Illness: Non-Traditional Family Therapy Assessment and Intervention Approach

Chronic illness is a major life-altering experience that impacts families around the world. In this article, a nontraditional, culturally appropriate family therapy assessment procedure is presented that can serve as a catalyst for creating change in families with a chronically ill member. As an ecological and holistic assessment tool, the Intervention Based Family Assessment Procedure (IBFA) helps to build a family's story by identifying needs, exploring sources of stress, assessing coping strategies, and determining how support systems are activated to help the family with the care of a chronically ill family member.

Low-intensity family therapy intervention is useful in a clinical setting to treat obese and extremely obese children

To study the influence of low-intensity solution-focused family therapy with obese and extremely obese pediatric subjects on body mass index (BMI) z-scores and self-esteem. Fifty-four obese children, aged 6-17 years, were referred to an outpatient obesity clinic. The families received solution-focused family therapy provided by a multidisciplinary team. Height and weight were recorded; BMI and BMI z-scores were derived. Self-esteem was assessed with a validated questionnaire, "I Think I Am." Parents completed "The Family Climate Scale" assessing family dynamics. Eighty-one percent of the children (n =44, mean age 11.9 years, mean BMI z-score 3.67, range 2.46-5.48) and their parents participated in the follow-up. Eleven children were treated for 6-12 months, and 33 for more than 12 months. On average, the families received 3.8 family therapy sessions. Intervention resulted in a mean decrease in BMI z-score of 0.12 (p =0.0001). Self-esteem on the global scale improved after intervention (p =0.002), and also on sub-scales, depicting physical characteristics (p <0.001), psychological well-being (p =0.026), and relations with others (p =0.046). The Family Climate Scale showed improvement in the sub-scales for Expressiveness (p = 0.002) and Chaos (p =0.002). Solution-focused family therapy provided by a multidisciplinary team to obese and extremely obese children may prove useful in the clinical setting, with a positive impact on obesity and self-esteem.

When Baby Brings the Blues: Family Therapy and Postnatal Depression

Postnatal depression impacts on a significant number of women and their families. As a topic it is attracting much interest from researchers as we become clearer about its impact on the long‐term mental health of both women and their partners, as well as on the couple's relationship and their children's mental health. This article will provide a brief overview of postnatal depression and the current research associated with it, and consider the usefulness of systemic family therapy interventions. Examples of these are included along with a clinical vignette.