Family Therapy Services Research Articles

Predictors of Outpatient and Inpatient Service Utilization Among Publicly-Insured Youth With Eating Disorders.

Although eating disorders (EDs) affect youth from all socioeconomic backgrounds, little is known about the treatment experiences of under-resourced youth with EDs. To address this gap, we examined patterns of outpatient and inpatient service utilization among publicly-insured youth with EDs in California and potential disparities for youth with additional marginalized identities. Participants were identified from the full sample of California Medicaid/Medi-Cal beneficiaries aged 7-18 with ≥ 1 service episode between January 1, 2014 and December 31, 2016. Claims data were extracted for youth with a full year of claims after the first known ED diagnosis (N = 3311) to analyze outpatient mental health, outpatient medical/physical, inpatient mental health, and inpatient medical/physical service use across ED diagnosis and demographic characteristics (sex, age, race/ethnicity, and preferred language). Outpatient individual and family therapy service utilization was low across ED diagnoses (4-7 individual therapy sessions and ≈5 family therapy sessions annually). Conversely, hospitalization rates were high, particularly among youth with anorexia nervosa (27.8%) and bulimia nervosa (30.0%). Youth with other specified feeding or ED had high medical service utilization, with more days of outpatient medical care and greater odds of medical hospitalization than youth with all other diagnoses. Latinx youth, Black youth, and boys tended to receive fewer services after accounting for diagnosis, with disparities particularly pronounced for Latinx youth. Publicly-insured youth with EDs in California experience high hospitalization rates but receive limited outpatient therapy. Additional research is needed to identify possible unmet needs and factors contributing to treatment disparities among these youth.

Who and what supports systemic working in a learning disabilities context?

PHOTO CREDIT: Hannah Busing, UnsplashThis article sets out some of the many ways in which systemic working can find a place in Learning Disability (LD) services. It covers ways in which systemic working can influence different aspects of work in an LD service, possibilities for embedding systemic approaches in Positive Behaviour Support (PBS) work in an Enhanced Support Service (ESS), systemic consultation in an LD team, systemic working in a forensic LD service and a specialist LD family therapy service. We hope the article offers a range of ideas which others can draw upon in thinking about their own context, practice and future possibilities.

Sensitivity to change of the Systemic Therapy Inventory of Change (STIC) intersession scales

Objective: The Systemic Therapy Inventory of Change (STIC) is a systemic measurement feedback system that provides therapists with feedback regarding the multidimensional clinical change in individual, couple, and family therapy. The STIC Intersession scales include Individual Problems and Strengths (IPS), Relationship with Partner (RWP), Family/Household (FH), and Child Problems and Strengths (CPS). They are administered to clients before each therapy session. The purpose of the current study is to investigate the STIC Intersession scales’ sensitivity to change, the ability to detect reliable and valid changes that occur after an intervention. Method: Participants (N = 583) who voluntarily received individual, couple, or family therapy services in a randomized clinical trial attended the study. Results: By comparing the changes in pre-therapy and post-therapy scores of the STIC Intersession scales with those of the corresponding reference measures, the external sensitivity to change of the STIC Intersession scales was supported. The IPS Intersession scale showed greater change than the Beck Anxiety Inventory. However, no evidence supported the discriminant validity of CPS’s change scores. Conclusion: Thus, the STIC Intersession IPS, RWP, and FH can be validly used to assess multi-systemic changes in both research and clinical work.

Walk‐in Together: A pilot study of a walk‐in online family therapy intervention

AbstractMany Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk‐in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof‐of‐concept study investigating the acceptability and short‐term effectiveness of an online walk‐in family therapy service, Walk‐in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk‐in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre‐session, post‐session, and at 6 weeks follow‐up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi‐structured interview data. Post‐session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post‐session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well‐received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk‐in delivery model. This proof‐of‐concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk‐in, telehealth model to meet the rising demand for therapeutic support for families in distress.

Workforce training in family therapy and systemic practices: An evaluation framework and case study

AbstractInternationally, while the interdisciplinary field of family therapy and systemic practices is well established and evidence for therapeutic impact is advanced, evaluation of training and measurement of its impact lags behind. This paper addresses this gap, utilising a single case study at the Bouverie Centre, the largest family therapy and workforce development service in Australia. We describe (a) the scope of workforce training and implementation at the Centre, (b) the development of our training research and evaluation framework, and (c) standardised data collection methodology, including a pre‐post training reflective survey. Collectively, this work comprises our current evaluation framework through which we will subsequently examine training impact. Future research and practice recommendations are offered to address challenges to workforce training evaluation and progress efficacy of family therapy training.

Mental health, perceived consensus of coparenting, and physical health among incarcerated fathers and their nonincarcerated, romantic partners.

Incarcerated fathers and their coparenting partners experience serious challenges to their health and well-being, beyond the general population. The interdependent nature of romantic involvement and coparenting a child suggests that self-reported mental health and the perceived consensus of the coparenting relationship may predict the physical health of not only the individual, but their partner. We use Actor-Partner Interdependence Modeling (APIM) for 483 romantically involved coparents from the Multisite Family study on Incarceration, Parenting, and Partnering to explore this link. Each dyad consists of an incarcerated male and a nonincarcerated female. Results indicate a significant link between mental and physical health for each dyad member (actor effects). Additionally, a partner effect links perceived consensus of coparenting from men to women, indicating that women whose partners reported a higher perceived consensus of coparenting also reported better physical health. Implications for marriage and family therapy, criminal justice, health, and human services policy are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

I have to hold it together: Trauma in law enforcement couples

AbstractObjectiveGrounded in secondary traumatic stress theory, this study explored the impact of work‐related traumatic stress on law enforcement couples.BackgroundStudies exploring the impact of traumatic stress on law enforcement couples are limited. Such studies suggest that when traumatic stress impacts law enforcement professionals, their spouses often experience secondary traumatic stress and serve in a supportive role after trauma exposure.MethodSemistructured dyadic interviews were conducted with law enforcement couples (N = seven couples, 14 participants) using transcendental phenomenology.ResultsThree themes emerged within the data that captured the essence of law enforcement couples' experiences of traumatic stress: (a) the stressful nature of the law enforcement profession, (b) the impact of work‐related traumatic stress on the couple relationship, and (c) protective factors and resilient coping characteristics.ConclusionThe impact of work‐related traumatic stress manifested in couple's communication, role responsibilities and parenting, and commitment to the relationship and the profession. The impact of work‐related traumatic events differed for the law enforcement professional and their spouse based on the type of traumatic event. Overall, work‐related traumatic stress led couples to engage in a meaning‐making process and activation of resilient couple coping characteristics.ImplicationsGiven the significant impact that work‐related traumatic stress has on the law enforcement couple dyad, couple and family therapy services are needed for law enforcement professionals and their spouses. Couple and family therapists, family researchers, and other professionals working to promote healthy couple and family relationships should inquire about how couples adapt to traumatic stress and reinforce use of resilient coping characteristics.

Psychometric properties of the SCORE‐15 Thai version and its relationship with mental health index

AbstractThe SCORE‐15 Thai version was developed for clinical use in Thailand. This study aims to assess the internal reliability of the SCORE‐15 Thai version and its convergent validity with the Chulalongkorn Family Inventory (CFI), a measure modified from the Family Assessment Device (FAD), the perceptions of the family problems, and the mental health index. It exhibited a strong negative correlation with the CFI, a moderate negative correlation with the manageability rating and a weaker positive correlation with the severity rating. The internal reliability of both full‐scale and subscales of the SCORE‐15 was all good except for the communication subscale. The SCORE‐15 also showed a discriminative pattern among participants with varying states of mental health. In conclusion, the SCORE‐15 Thai version was generally a valid and reliable tool for family assessment in the clinical Thai population. Practitioner points It is essential to locally develop family assessment tools that are appropriate for the socio‐cultural context of the family therapy services. The SCORE‐15 Thai version generally exhibited acceptable internal reliability and good convergent validity with the CFI in the clinical Thai population. The family functioning and the manageability rating of the SCORE‐15 Thai version were significantly different among groups of people with varying states of mental health.

Whose Life is it Anyway? Exploring the Social Relations of High-Conflict Divorce Cases in Southern Norway

The paper reports on findings from an empirical study based on qualitative interviews with Norwegian parents identified as part of a high-conflict divorce situation and interviews with caseworkers from a child welfare service. The site of study is an institutional circuit of concern, assessment, and referral involving the court, child welfare services, and a public family therapy service. The paper draws on the social ontology and analytic concepts of institutional ethnography and adopts parents’ standpoint to explore how their knowledge and experience are shaped through encounters with professionals in the process of being identified and assessed as a high-conflict divorce case. The focus on people’s doings and their expert knowledge about their doings sets institutional ethnographic research apart from more conventional forms of qualitative inquiry that focus on informants’ inner experience. The paper highlights how a generalized professional discourse seems to permeate the work that parents and caseworkers jointly engage in, sometimes subsuming the knowledge and experience of those involved. When the issues of life as subjectively known and experienced are different from those of the institutional discourse, there is a danger that what is important to those whose lives they concern escapes the dialogue between parents and professionals.

Monitoring and Managing Depressive Symptoms in Adolescents with Epilepsy

Depressive disorders are the most frequent psychiatric disturbances associated with epilepsy in adolescents and include a broad and heterogeneous spectrum of conditions that share hallmark features and symptoms such as sadness, irritability, decreased motivation or interests, fatigue, withdrawal, hopelessness, anhedonia, changes in appetite and weight, and sleep disturbances that are persistent and pervasive most days for at least 2 weeks. Using generic self-report depression surveys and current diagnostic codes, clinical and surveillance studies have revealed prevalence rates of 20–25% for depression in youth with epilepsy, with adolescents showing particular vulnerability. Furthermore, 20% of youth with epilepsy endorse suicidal ideation, and youth endorsing suicidal ideation do not necessarily have clinical symptoms of depression. Considering that depression in youth with epilepsy is a common comorbidity, characterized by poorer psychosocial and healthy-related outcomes and increased risk of suicide, a brief, free measure of specific depressive symptoms in youth with epilepsy would be beneficial. Recently, the NDDI-E-.Y inventory has been developed from the adult NDDI-E, and validated in many countries. NDDI-E-Y showed reliable and construct validity, being a brief screening tool (12 items) that can be easily included in routine epilepsy care.For the management of depressive symptoms in adolescents, interventions can be distinguished in non-pharmacological and pharmacological. The first includes psychoeducation which should clarify to adolescents and parents the main features of epileptic disorder, side effects of antiepileptic drugs, treatment modalities, how to cope with learning and social difficulties, in order to improve quality of life. Concurrently, a cognitive-behavioral therapy (CBT) including individual therapy, supportive and family therapy and school services, should be carried on. Psychopharmacology for depressive symptoms should be deserved to moderate to severe depressive symptomatology, only after deep assessment of prior and current antiepileptic and/or psychopharmacologic treatment. SSRIs including fluoxetin, sertraline, fluvoxamine and escitalopram should be first considered. Data coming from experimental studies in animals and humans seem to confirm no decrease of seizure threshold by SSRI adjunctive therapy.

Putting the Blame on Others in Suicide Notes From Shanghai and Wuhan, China.

Background: Suicide note leavers sometimes blame others for their death. The blame could reveal extrinsic suicide risk factors and thus countermeasures may be ascertained. Aims: This study included suicide note leavers in Shanghai and Wuhan (n = 555) to examine (a) who was inclined to put the blame (b) on whom and (c) for what reason(s). Method: Logistic regressions were used to compare the note leavers who blamed others with those who did not. Cramer's V tests were used to examine the correlations between the note leavers' demographics and the targets of the blame. Results: Note leavers who used poisoning and cutting were more likely to blame others compared with those who used jumping, drowning, and hanging. Non-native note leavers tended to more frequently blame social problems and their workplaces compared with the natives. The common reasons for the blame on nonfamily members, children, and lovers/spouses were being mistakenly blamed for something, being disobedient, and having conflicts/hatred, respectively. Limitations: Some blame could have been made under the influence of psychiatric disorder/substances, and thus potentially deviated from the facts. Conclusion: Emotional/marriage consultations and family-therapy services should be made available to females experiencing love/family crises. Mental health services in the workplace could help reduce suicide risks.

The Systemic Therapy Inventory of Change (STIC) Initial Scales: Are they sensitive to change?

The Systemic Therapy Inventory of Change (STIC) is a multisystemic and multidimensional feedback system that provides therapists feedback about systemic domains of client change in individual, couple, and family therapy over time. The goal of the present study is to investigate the sensitivity to change of the scores of the STIC Initial Scales. In total, 583 clients who voluntarily sought individual, couple, or family therapy services and participated in a randomized controlled trial study were included in the study. Their pre- and posttherapy responses to the STIC Initial measures and corresponding validation measures for individual functioning, couple relationship, child adjustment, and family functioning were compared. The results support the sensitivity to change of the scores of the four STIC Initial Scales investigated: Individual Problems and Strengths (IPS), Relationship with Partner (RWP), Family/Household (FH), and Child Problems and Strengths (CPS). Of particular note, the IPS demonstrated even greater change over time than the BDI-II, BAI, and OQ-45. The discriminant validity of measuring change with the CPS was not supported. Thus, the STIC Initial IPS, RWP, and FH can be usefully employed to measure multisystemic changes in both research and clinical work. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Initial validation of the dyadic coping inventory for financial stress.

Financial stress can have a detrimental impact on a couple's relationship but there is no validated instrument to assess the way couples cope with financial stress. This study sought to validate the Dyadic Coping Inventory for Financial Strain (DCIFS), an adaptation of the Dyadic Coping Inventory to financial stressors, with self-report data collected from 132 heterosexual couples seeking couple and/or family therapy services. Confirmatory Factor Analysis results supported a 23-item version consisting of the following subscales for both men and women: Stress Communication by Oneself and by Partner; Emotion and Problem-Focused Supportive Dyadic Coping (DC) by Oneself and by Partner; Negative DC by Oneself and by Partner; Emotion and Problem-Focused Common DC; and Evaluation of DC (Chi-square test: Men: χ2 (175)=310.11, p=0.00; Women: χ2 (175)=242.88, p=0.00. Results also supported the hypothesized factorial structure for the aggregated subscales of DC by Oneself and by Partner as well as the discriminant, predictive, and convergent validity of the DCIFS. Findings associated with the Stress Communication subscales suggest that this DC dimension may behave differently depending on the type of stressor. Further studies should be conducted to replicate the DCIFS factorial structure with longitudinal data from couples not seeking couple or family therapy.

The Necessity of Integrating Family and Couple Therapy Services in Primary Healthcare Programs

The Necessity of Integrating Family and Couple Therapy Services in Primary Healthcare Programs

Psychological Needs in Post-Genocide Cambodia: The Call for Family Therapy Services and the Implications for the “Majority World” Populations

ABSTRACTDuring the Khmer Rouge reign in Cambodia from 1975 to1979, approximately one-quarter of the country’s population lost their lives by starvation, disease, or execution. Most intellectual and academic institutions, including mental health services, were destroyed during this period by the Khmer Rouge regime who saw them as a threat. About 15 years ago mental health services began to be reinitiated in the country, usually in collaboration with Western academics and mental health experts. The call for these services was often in response to the high prevalence of post-traumatic stress disorders and other psychosocial problems. Today mental health issues still receive insufficient attention in Cambodia, mainly stemming from a lack of resources, knowledge about the general topic of mental health, and stigma. This article presents the results of a survey delivered to the first generation of psychology students since the end of the Khmer Rouge regime regarding their impressions of the current mental health needs in Cambodia. Respondents answered questions about the types of problems people bring to Cambodian counselors and therapist, the clinical populations in their work settings, their views of preferred treatment approaches in Cambodia, barriers to service delivery, and types of training needed to address the concerns of the people of Cambodia. The leading requests for the future development of mental health training included the need for training in marriage and family therapy, assessments, and play therapy. Domestic violence, depression, and anxiety/stress were also placed at the top of the mental health issues reported.

Adopting Minds — a mentalization-based therapy for families in a post-adoption support service: preliminary evaluation and service user experience

Children placed for adoption often face unique challenges and are at higher risk of mental health problems compared to the general population. Yet despite some important clinical developments, there is still a lack of evidence related to effective therapeutic interventions for this population. This study reports on the preliminary evaluation of a mentalization-based family therapy service, Adopting Minds, offered as part of a post-adoption support service. Thirty-six families who had adopted 42 children were referred to the service between September 2015 and December 2016. Demographic information was collected and assessments undertaken on the families at baseline and at the end of therapy, using a range of validated measures. Five families who had completed therapy were also interviewed about their experience of the approach. For those families on which data were available, positive outcomes in mental health and parental self-efficacy were identified, and adoptive parents reported high levels of satisfaction with the mentalization-based family therapy service. Analysis of the interviews revealed that the families found it a containing space that was supportive and non-judgemental. They felt able to express their fears and worries to a therapist who was friendly and knowledgeable and reported that the service helped them to deal with and link struggles they were facing to their own as well as their child's past experiences. However, some adoptive families felt that this short-term, six-session service alone was not enough to address all the difficulties that had brought the family to seek help, and would have preferred a longer-term intervention or therapy in combination with other types of support.

Distilling the Core Elements of Family Therapy for Adolescent Substance Use: Conceptual and Empirical Solutions

ABSTRACTThis article describes several barriers to widespread dissemination of manualized family-based treatments for adolescent substance use (ASU). We then offer a highly promising solution for adopting and sustaining family therapy in usual care: distilling the core practice elements of empirically validated family therapy models for ASU. We present a conceptual distillation of family therapy for ASU grounded in existing observational fidelity measures for three manualized models, a process that yielded four core elements: Family Engagement, Relational Reframing, Family Behavior Change, and Family Restructuring. We then introduce an innovative empirical method for distilling core elements that can serve as a template for rigorous distillation of other treatment approaches. Finally, we discuss how core elements can enhance family therapy services within the diverse workforce of usual care for ASU.

Perceived Needs for Support Program for Family With Child Sexual Abuse Victim in South Korea: Focus Group Interview With Therapists and Mothers

ABSTRACTThis study assessed perceived needs for psychological support program for family with victim of child sexual abuse in South Korea. We conducted two separate focus group interviews with five therapists who served child sexual abuse victims and families as well as four mothers of a child sexual abuse victim. Consensual qualitative research analysis revealed four domains: Emotional support for parents, psychoeducation, family therapy, and tailored and flexible service delivery. Core ideas of the four domains were identified. The results were consistent with the family support program contents developed in Western countries and suggested culture-specific contents and culturally sensitive service delivery. Clinical implications for developing family support program in South Korea were discussed.

Dialogical Research in Supervision: Practical Guidelines from Experienced Supervisors in Family Therapy, Child Protection, and Specialty Mental Health Services

This two‐year qualitative participatory research project examines practical guidelines for supervision. Sixteen experienced supervisors across professional settings of family therapy, child protection, and specialty mental health services in the geographical regions of Northern Norway and Northern Sweden outline four main practical guidelines in supervision based on their supervisory practices: (1) elaborating an agreed‐upon contract; (2) exploring potential formats; (3) exploring contents; (4) acknowledging responsibility for process and dilemmas. Participants summarised how they generated mutual growth in supervisory relationships, while being respectful of the first‐person perspective of supervisees. The study challenges pre‐dominating guidelines about deficit‐ or developmental stage‐oriented supervision. It illustrates reflecting processes and a polyphonic orientation in supervision by welcoming diversity, wondering, and tolerance for the not‐yet‐decided among involved persons in a mutual exploration and calibration of relevant knowledge. It outlines a dialogical research for sharing, exploring, and questioning knowledge as beneficial for whom, told by whom, and evaluated by whom.

Becoming invisible: The effect of triangulation on children's well-being.

The study explored children's experience of triangulation in their families. In all, 15 children aged 11-16 years, who were attending an early intervention family therapy service, participated in the study. The children's understandings and emotional experience of triangulation were explored by comparing their responses to pictures from the Separation Anxiety Test (SAT) and a set of pictures designed for the study depicting a variety of triangulation conflicts in families. An interview regarding the children's personal family experiences of triangulation was also undertaken and clinical information about the children's family contexts was also utilised. Statistical analysis was conducted based on eight of children for whom a full data set was available. This indicated that children showed greater levels of anxiety in response to the triangulation as opposed to the separation scenarios. Qualitative analysis supported this finding and revealed that many of the children felt 'invisible' due to parents' pre-occupation with marital conflict, felt caught in the middle of conflicts and coerced to take sides. Although able to describe their reactions and showing greater negative emotional responses to the triadic pictures, they were not consciously aware of the negative impacts of triangulation on their sense of well-being. Clinical implications are discussed with a focus on encouraging child-centred approaches to family therapy.