Family Therapy Interventions Research Articles

A randomized clinical trial of family therapy in juvenile drug court.

Clinical Trials.gov, Identified NCT01668303.

Parenting and Child Mental Health

Parenting behavior has a significant influence on children’s mental health and may contribute to the development of emotional or behavior problems in children. Differences in parenting behavior have been related to parent personality and to child temperament, although the direction of causality is not yet clear. This review seeks to provide an overview of the relation between child mental health, parenting, parent personality, and child temperament with a special focus on the interaction effects of parent personality on child temperament. Empirical evidence suggested that child and parent characteristics both—additively and interactively—contribute to parenting behavior. There were only a few studies that explicitly considered interaction effects, and most of them focused on negative effects. More research is necessary to investigate the interaction of parent personality and child temperament and the related child outcomes further. Counseling, family therapy, and other parenting-oriented interventions may benefit from individual adaptations to both parental personality and child temperament.

Emotion-Focused Family Therapy for Eating Disorders Across the Lifespan: A Pilot Study of a 2-Day Transdiagnostic Intervention for Parents.

Emotion-focused family therapy is a transdiagnostic approach that affords parents and caregivers a significant role in their loved one's recovery from an eating disorder. A 2-day intervention was developed on the basis of emotion-focused family therapy principles and delivered to 33 parents of adolescent and adult children. Data were collected pre- and post-intervention. Through education and skills practice, parents were taught strategies with respect to meal support and symptom interruption as well as emotion coaching. Parents were also supported to identify and work through their own emotional blocks that could interfere with their supportive efforts. Analyses revealed a significant increase in parental self-efficacy, a positive shift in parents' attitudes regarding their role as emotion coach and a reduction in the fears associated with their involvement in treatment, including a decrease in self-blame. Overall, this broad-based, low-cost intervention shows promise, and future research is warranted. Copyright © 2014 John Wiley & Sons, Ltd. A low-cost, intensive emotion-focused family therapy intervention shows promise for parents of individuals with an eating disorder, regardless of their loved one's age, symptom profile or involvement in treatment. Working with parents' emotions and emotional reactions to their child's struggles has the potential to improve supportive efforts. An emotion-focused family therapy intervention for parents yields high satisfaction rates, improves parental self-efficacy and reduces fears regarding their involvement, including self-blame.

Differential effects of the working alliance in family therapeutic home‐based treatment of multi‐problem families

Families with a low socioeconomic status play an increasingly significant role in health services, research and social policy. The present outcome research study is a pre/post naturalistic study of home‐based therapeutic work with multi‐problem families (MPF), as conducted by Therapeutisch Ambulante Familenbetreung, an integrative family therapy with a structure‐related, mentalization‐based, psychoanalytic orientation. With a mean treatment duration of 75.7 weeks, 379 families showed significant psychological improvement on 10 scales concerning patient–therapist collaboration, treatment expectancy and psycho‐social outcome measures with a medium to large effect size for all parameters (range: .35–1.49). About two‐thirds of the sample improved by two SD on individually set treatment goals, further supporting the clinical significance of the therapeutic effect of home‐based family treatment. Improvements in goal‐directed collaboration and treatment expectancy are shown to be related to clinical improvement. Structural family therapy interventions for families with multiple problems thus benefit from individually setting goals and improving their self‐efficacy and problem‐solving by means of improved treatment expectancy.Practitioner's points MPF constitute a significant problem in healthcare and costs (burden of disease). The treatment of MPF is considered relatively difficult. Improvements to the process quality (working alliance, treatment expectancy) increase the quality of the results of home‐based treatment of MPF.

World of Warcraft: A Family Therapist's Journey into Scapegoated Culture

Relational (online) video games are lucrative business. The extremely popular Massive Multiplayer Online Role Playing Game, World of Warcraft, boasts over eight million paying users. Video games are also a lightning rod for criticism and contempt by news media, parents and policy makers as the number of mass shootings increases in the United States. There is some research suggesting violent video games increase violent cognition and behavior. There is other research arguing no relationship exist between violent gaming and aggression. The same dichotomy of views exists within the discussion of how relational video games impact intimate partnerships. The purpose of this study is to continue conversation into the possibility of using games like World of Warcraft as interventions in individual, couple and family therapy. This autoethnorgraphic work examines researcher experience in World of Warcraft and its impact on violent thought, behavior and intimate relationships. In addition to researcher self-exploration, extensive interviews were conducted to provide additional context. Throughout the course of this work, three themes of World of Warcraft culture emerged: Work, Nostalgia and Connection. The theme of connection was most pervasive to the researcher and the participants. Video games like World of Warcraft may present supplemental opportunities for clients to practice healthy connection. Concerned parents should monitor their children’s online gaming relationships as they would any other. Future research in this area may benefit from an experimental design where video games like World of Warcraft are used in the treatment of PTSD and Social Anxiety Disorder.

Intensive Treatments for Pediatric Obesity: An Acceptability Analogue Study

Objective: Stagnant effect sizes in controlled trials of treatment for pediatric obesity have led to calls for “more powerful” interventions. Multisystemic family therapy (MSFT), pharmacological interventions, bariatric surgery, eHealth, and residential treatments all show promise for extending the effectiveness of family-based programs. However, it is not clear if the consumer public would find one intensive approach more acceptable than another. Methods: The current study used treatment acceptability analogue methodology to assess the relative acceptability of the treatments listed above. Vignettes describing an adolescent with obesity suffering from diabetes were administered to 626 undergraduate students (age M = 19.15 ± 1.84). Participants read about the five intensive treatment options including descriptions of expected benefits and side effects. They were then asked to rate the acceptability of each treatment using an adapted version of the Obesity Treatment Acceptability Questionnaire. Results: A two-way ANOVA with repeated-measures on the treatment acceptability factor revealed significant mean differences in acceptability between the treatment approaches F(2.95,1844.41) = 160.028, p < 0.001, partial η2 = 0.204). Post-hoc analyses revealed MSFT and eHealth approaches were more acceptable than residential, surgical, and pharmacological approaches. Conclusion: Results indicate consumers prefer approaches that can be conceptualized as increased “dose” of traditional family-based behavior therapy for obesity.

Validity of therapist self-report ratings of fidelity to evidence-based practices for adolescent behavior problems: correspondence between therapists and observers.

Developing therapist-report fidelity tools to support quality delivery of evidence-based practices in usual care is a top priority for implementation science. This study tested the reliability and accuracy of two groups of community therapists who reported on their use of family therapy (FT) and motivational interviewing/cognitive-behavioral therapy (MI/CBT) interventions during routine treatment of inner-city adolescents with conduct and substance use problems. Study cases (n=45) were randomized into two conditions: (a) Routine Family Therapy (RFT), consisting of a single site that featured family therapy as its standard of care for behavioral treatment; or (b) Treatment As Usual (TAU), consisting of five sites that featured non-family approaches. Therapists and trained observational raters provided FT and MI/CBT adherence ratings on 157 sessions (104 RFT, 53 TAU). Overall therapist reliability was adequate for averaged FT ratings (ICC=.66) but almost non-existent for MI/CBT (ICC=.06); moreover, both RFT and TAU therapists were more reliable in reporting on FT than on MI/CBT. Both groups of therapists overestimated the extent to which they implemented FT and MI/CBT interventions. Results offer support for the feasibility of using existing therapist-report methods to anchor quality assurance procedures for FT interventions in real-world settings, though not for MI/CBT.

Intervención en terapia familiar comunitaria con diez familias caleñas de la ladera oeste

Intervención en terapia familiar comunitaria con diez familias caleñas de la ladera oeste

Therapy with Families in China: Cultural Factors Influencing the Therapeutic Alliance and Therapy Goals

Rapid economic and social development in China is producing opportunities for a better standard of living for many families but also is associated with significant stress. Family therapy is one of the forms of mental health services that have become increasingly available. Western-derived models of family therapy are being used and adapted to meet the cultural traditions and needs of Chinese families. This article describes a variety of Chinese cultural factors that can influence the establishment of therapeutic alliances with family members (communication styles, collectivist values, family roles, and structure) and those that can shape family therapy interventions by addressing contextual factors affecting Chinese families (economic development, migration patterns, academic pressure, and changing gender roles for women). Suggestions are offered for using cultural sensitivity to address these factors tactfully to build strong therapeutic alliances and help families cope with significant life stresses.

Attachment-based family therapy interventions.

Attachment-Based Family Therapy is a treatment model designed specifically for depressed and suicidal adolescents. The primary goal of the treatment is to promote developmentally appropriate adolescent-parent attachment. Three core interventions are discussed: relational reframes; focusing on primary emotions and unmet attachment needs; and facilitating corrective attachment episodes. For each intervention, the theoretical/clinical rationale is presented followed by a brief illustration and relevant research findings.

The evidence base for family therapy and systemic interventions for child‐focused problems

This review updates similar articles published in the Journal of Family Therapy in 2001 and 2009. 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 multi‐modal programmes for sleep, feeding and attachment problems in infancy; child abuse and neglect; conduct problems (including childhood behavioural difficulties, attention deficit hyperactivity disorder, delinquency and drug misuse); emotional problems (including anxiety, depression, grief, bipolar disorder and self‐harm); eating disorders (including anorexia, bulimia and obesity); somatic problems (including enuresis, encopresis, medically unexplained symptoms and poorly controlled asthma and diabetes) and first episode psychosis.

The evidence base for couple therapy, family therapy and systemic interventions for adult‐focused problems

This review updates similar articles published in JFT in 2000 and 2009. It presents evidence from meta‐analyses, systematic literature reviews and controlled trials for the effectiveness of couple 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 multi‐modal programmes, for relationship distress, psychosexual problems, intimate partner violence, anxiety disorders, mood disorders, alcohol problems, schizophrenia and adjustment to chronic physical illness.

The perfect marriage: solution-focused therapy and motivational interviewing in medical family therapy.

Medical family therapy has many potential uses in behavioral medicine and primary care. Current research was reviewed to determine the most advantageous way to apply solution-focused therapy and motivational interviewing as a perfect marriage in medical family therapy. An extensive literature review was done in the following databases for medical family therapy: Proquest, EBSCO, Medline, and PsychInfo. The search resulted in 86 relevant articles, of which 46 of the most recent were selected for review. Medical family therapy lacks current research that supports solution-focused therapy or motivational interviewing. However, evidence supports the use of solution-focused therapy as a brief format, as well as the closely related intervention, motivational interviewing. While medical family therapy presents many hopeful possibilities in the fields of behavioral medicine, psychology, and marriage and family therapy, little evidence currently exists for the most effective implementation. This review found evidence supporting solution-focused therapy and motivational interviewing as the perfect marriage of the collaborative team approaches for the future implementation and use of specific interventions in medical family therapy.

Health correlates of co-occurring substance use for women with HIV in cocaine use recovery

BackgroundThe goal of this study was to examine clinical correlates of alcohol, opioid, cannabis, sedative, or other co-occurring substance use disorders in a sample of 124 HIV+ women in recovery from cocaine use disorders. MethodsData was collected from a baseline assessment for a randomized trial comparing a family therapy intervention to a health promotion group intervention. Substance use disorders were assessed with a computer-administered structured diagnostic interview. Psychological distress was measured with the Brief Symptom Inventory. Sleep problems were measured with the Short Sleep Index from the Hamilton Anxiety and Depression Rating Scales. Pain was assessed with items from the Medical Outcomes Study—HIV scale. HIV health was assessed with blood tests for T-cell count and HIV Viral Load Suppression, as well as a nurse-administered symptom assessment. ResultsWomen with a co-occurring opioid use disorder were significantly more likely to have psychological distress and sleep problems, but less likely to have severe pain. Even though there was no difference in T-cell count or Viral Load, women with opioid use disorder were significantly more likely to have high HIV symptoms. ConclusionsWomen in recovery with HIV who have co-occurring cocaine use and opioid use disorders were more likely to have several indicators of worse mental and physical health. Interventions may need to be tailored to meet the needs of this subgroup of women. Future research should examine whether these co-occurring conditions are associated with greater likelihood of relapse or poor treatment response, and whether this higher-risk profile exists in other groups.

Evaluation of functional family therapy in an Irish context

In an Irish context we conducted a retrospective archival study of functional family therapy (FFT) for adolescents with behavioural problems. Strengths and difficulties questionnaire data were collected from 118 families at the beginning and end of therapy (at baseline and follow up for dropouts) in a community‐based clinic in a socially disadvantaged Dublin suburb. Analyses of the improvement in mean scores and clinical recovery rates showed that the outcome was associated with treatment completion and the extent to which therapists adhered to the FFT treatment manual. Therapy completers treated by high‐adherent therapists had the most favourable outcome. In contrast, the worst outcome occurred for dropouts. The outcome of cases treated by low‐adherent therapists fell between these two extremes. These results show that FFT may be effectively implemented in an Irish context, and that the effectiveness of treatment is associated with families remaining in treatment for an average of seventeen sessions, and receiving treatment from therapists who implement FFT with a high degree of fidelity.Practitioner points Use functional family therapy to treat adolescents with behavioural problems. To maximize benefits to clients, adhere to the functional family therapy treatment protocol when conducting therapy.

An Adapted Brief Strategic Family Therapy for Gang-Affiliated Mexican American Adolescents

Objective: This study assessed the effectiveness of an adapted Brief Strategic Family Therapy (BSFT) intervention for gang-affiliated Mexican American adolescents and their parents. Methods: A total of 200 adolescents and their family caregivers were randomized to either a treatment or a control condition. Outcomes included adolescent substance use, conflict resolution, gang identification, parent substance use knowledge, gang awareness, family cohesion, child conduct problems and stress. Participants were assessed at baseline, treatment exit at 16 weeks, and 6 months follow-up. General linear mixed-effects and generalized estimating equations models were used to evaluate between-group differences in outcomes. Results: There were significant differences between the BFST and control groups on adolescent alcohol use at 6 months and parents’ reported conduct problems. No impact on marijuana use was found. Conclusions: Results provide emerging evidence supporting the adapted BSFT for gang-affiliated Mexican American adolescents and their families for alcohol and behavioral outcomes. Future adaptations may be needed to reduce drug use.

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.

Special Section: Community Approaches to Problems: Beyond Individual and Family Solutions

I am delighted to introduce this special issue, which brings together a range of community approaches to problems which counselors and social workers might otherwise address through more conventional individual, family therapy, or social work interventions. Each of these articles proposes a direct inclusion of social or cultural engagements as part and parcel of work alongside clients. This kind of therapeutic and social work has implications for theory—for example, how to locate problems and alternatives to them—and implications for practice: how is community defined “on the ground?” In what arenas do “therapy” and social work take place? These articles share some theoretical legacies. Primarily, each paper critically questions long-standing assumptions within counseling and social work that locate problems and solutions within individuals. As Walters, Carter, Papp, and Silverstein (1988) first argued some time ago with reference to gender, even systems approaches which appear to transcend individuality can reinforce culturally dominant ideas about individual roles, responsibilities, or transactions. In contrast, the authors contributing to this special issue posit what Johnella Bird (2004) has called a relational “I”: an understanding of identity as intimately and ongoingly created within a matrix of collective and mutable meanings and practices. With this understanding, change occurs via transformational action in wider social contexts. As McNamee and Gergen (1999) suggest, problems and their alternatives exist in a social realm of relational responsibility. The authors here demonstrate a way of thinking and working that shares much with Winslade and Williams’s (2012) book Safe and Peaceful Schools, which addresses the problem of bullying. Rather than focus on individual change, Winslade and Williams aim to change bullying relations. Such a project of change engages peers and bystanders to help create and grow a preferred social reality in schools, guarding against the isolation and self-policing that can result from more conventional approaches to bullying. The contributors to this special issue document similar approaches to the particular problems they address. As Peggy Sax notes

‘I Will Not Leave My Baby Behind’: A Cook Island Māori Family's Experience of New Zealand Māori Traditional Healing

Traditional healers in many parts of the world have used family focused understandings and interventions well before the emergence of western family therapy theory and practice. This paper gives a detailed account of New Zealand Māori traditional healing work with a Cook Island Māori family in which the eldest daughter was in considerable distress as were her family, who believed that she had become maki tūpāpaku (possessed). This account is told from the perspectives of the child psychiatrist, the traditional healer and the mother of the family. While the intervention bears a superficial resemblance to western family therapy approaches, the theoretical foundation reflects the traditional healer's New Zealand Māori world views in which spiritual understandings are paramount, and concepts of mana, tapu and mauri guide him in the family healing process. The single session described here can be viewed as an indigenous family therapy intervention involving six generations of family members, both living and deceased, in the one room. Conclusions: Indigenous communities have called for traditional healers to be employed alongside child mental health workers and family therapists who work with their communities. Close and sincere collaboration between an indigenous traditional healer and a health professional can offer a family in distress healing possibilities that may not be available to them in conventional child mental health or other family therapy settings.

A preview of the efficiency of systemic family therapy in treatment of children with posttraumatic stress disorder developed after car accident

Traumatic stress refers to physical and emotional reactions caused by events which represent a life threat or a disturbance of physical and phychological integrity of a child, as well as their parents or gaerdians. Car accidents are the main cause of posttraumatic stress disorder (PTSD) in children. The aim of this study was to preview clinical efficiency of systemic family therapy (SFT) as therapy intervention in treatment of children with posttraumatic stress disorder (PTSD) traumatized in car accident under identical circumstances of exposure. We pointed out the importance of specific family factors (family cohesion and adaptability, emotional reaction of the parents) on PTSD clinical outcome. The sample of this clinical observational study included 7-sixth grade pupiles--5 boys and 2 girls, aged 13. All of the pupils were involved in car accident with one death. Two groups were formed--one group included three children who were involved in 8 SFT sessions together with their families. The second group included 4 children who received an antidepressant sertraline in the period of three months. Two months after the car accident, before the beginning of the therapy, all of the children were the members of rigidly enmeshed family systems, considering the high average cohesion scores and the low average adaptability scores on the FACES III. Three months after the received therapy, having evaluated the results of the therapeutic approaches, we established that the adaptability scores of the families included in the SFT were higher than the scores of the families of the children who received pharmacotherapy with one boy still meeting the criteria for PTSD. Systemic family therapy was efficient in the treatment of children with PTSD, traumatized in car accident. Therapy efficiency was higher when both parents and children were included in SFT than in the case when they were not included in the family therapy. The change in the functioning of the family systems was not accidental or simply time-dependant, but it depended on the therapy which was applied and the increased level of family adaptability as the main risk factor of retraumatization.