Family Therapy Research Articles

What can we learn from critical, liberation, and decolonization community psychologists of the global South?

The first part of this article illustrates how democracies are in crisis in many European countries and in the United States. The second part describes three important theoretical and political contributions made by critical community psychologists, decolonization, and liberation community psychologists to find theoretical constructs and action strategies that could enrich mainstream European and North American Clinical and Community Psychology. The third part explores how a thousand clinical psychologists, especially family therapists worldwide, have, through the Assisi Manifest, denounced the increase in psychological problems worldwide and the need to work not only with families but in the communities where people live. The last part outlines the major theoretical constructs and intervention methodologies we can integrate into our European community psychology activities and how to transform our "community homes" to decrease polarization and foster dialogue to foster better capabilities to care for one another and solve local and planetary problems.

Systematic Review and Meta-Analysis: Multisystemic Therapy and Functional Family Therapy Targeting Antisocial Behavior in Adolescence

Youth criminal justice systems are under growing pressure to reduce re-offending behaviour and support young people's health and developmental needs. This systematic review and meta-analysis sought to synthesise evidence for two prominent community-based interventions for delinquent and antisocial behaviour, multisystemic therapy (MST) and functional family therapy (FFT). We searched Medline, PsycInfo, Scopus, Web of Science, and Social Services Abstracts for randomised controlled trials (RCTs) and quasi-experimental studies evaluating MST/FFT. Included studies involved participants aged under 18; included interventions targeted delinquent/antisocial behaviour, but not maltreatment. We estimated effect sizes for 6 primary outcomes, synthesising RCTs comparing MST/FFT to usual care using correlated hierarchical effects meta-analysis. We assessed risk of bias and evidence strength using best-practice tools. Given the additional resources needed to implement MST/FFT, we rated evidence strength against a minimum clinically important difference rather than a null effect. This study is registered with PROSPERO, CRD42021279736. We included 35 studies for MST (16 RCTs meta-analysed comprising 4095 participants, 26% female) and 19 studies for FFT (7 RCTs meta-analysed comprising 1471 participants, 22% female). MST had a likely clinically important effect on time in out-of-home care, but no clinically important effects on other primary outcomes (delinquency, new offences/convictions, placement in out-of-home care, substance use), with low-to-moderate evidence strength. FFT demonstrated possible clinically important effects for the number of new offences/convictions, time in out-of-home care, and substance use, but evidence strength was low. Contrary to reports in some evidence clearinghouses indicating that MST/FFT are supported by the highest level of evidence strength, there is limited evidence that these interventions are superior to usual care in reducing delinquent and antisocial behaviour in adolescence. These findings should be viewed in the context of important methodological differences with prior reviews, including the rating of evidence strength against a minimum clinically important difference.

The bottom-up approach in multigenerational family therapy: The child as the family guide.

In therapy, the child is mainly seen as a problem to be labeled or as a victim of various forms of abuse. The idea of the child as a therapeutic resource is the central point of my article where children's symptoms are quickly reframed and get a relational meaning in the family. Once the relational competence of the child is appreciated and his voice is heard, the child becomes a special guide to explore the emotional world of his family, and the genogram can provide a wonderful platform to start this therapeutic journey. Using a multigenerational lens, I describe how to explore family development with a "bottom-up approach."Intergenerational questions can be asked to the child and with his help relevant family events can emerge and broken bonds repaired. The therapeutic results I expect are the resolution of children's problems and family transformation.

Investigation the effect of Acceptance and Commitment Therapy (ACT) training on stigma and family functioning in family members of patients with psychiatric disorders: a randomized controlled clinical trial

BackgroundRegarding the prevalence and pervasiveness of psychiatric disorders, which significantly affect not only the patients themselves, but also their families, family therapy has emerged as a promising intervention. This research examined the effects of Acceptance and Commitment Therapy (ACT) on stigma and family functioning in family members of patients with psychiatric illnesses, demonstrating effectiveness in improving family functioning and coping strategies in the face of mental illness.MethodsThis randomized controlled clinical trial without blinding. Forty family members of patients with psychiatric disorders were randomly assigned to an intervention group (N = 20) or a control group (N = 20). The intervention group received ACT in eight weekly sessions, each lasting 90 min, while control group remained on a waiting list. Both groups were assessed at three time points: pre-intervention, post-intervention, and at a one-month follow-up. Data collection instruments included a demographic information questionnaire, a stigma assessment, and a family functioning measure. Data were analyzed using SPSS software version 23.ResultsA statistically significant difference was observed between the mean post-test and follow-up stigma scores of the intervention and control groups (P < 0.05). The intervention group’s mean scores showed a rising trend, whereas the control group’s mean scores showed a declining trend. This was evident from within-group comparisons of the mean post-test and follow-up stigma scores. Repeated measures ANOVA indicated that the pattern of change in stigma for the intervention group was significant, in contrast to control group, suggesting a reduction in stigma (P < 0.001).ConclusionIn light of the findings presented in this study, ACT emerges as a promising intervention for mitigating stigma, and enhancing the family functioning of individuals afflicted with mental disorders. To improve the generalizability of the study results, comparable studies using this therapy method should be undertaken on family caregivers of patients with mental illnesses.Iranian Registry of Clinical TrialsIRCT registration number: IRCT20190917044802N10.Registration date14/9/2023.

음주 문제가 있는 두 청년 내담자의 가족치료 사례연구

Objective: The purpose of this study is to examine factors influencing clients’ drinking problems and changes in clients and their families depending on intervention methods of therapists, focusing on two family therapy cases involving conflicts due to children’s drinking problems. Methods: The study utilized a case study method, allowing for an in-depth examination of the cases. Results: This study found that the factors influencing the children’s drinking problems included personal factors, family factors, and socio-cultural factors. Personal factors were high anxiety and avoidant tendencies. Family factors included issues stemming from the parents’ families of origin, negative parenting styles, dysfunctional communication methods, and a family culture tolerant of drinking. Socio-cultural factors included patriarchal culture and a preference for sons. Conclusions: The findings of this study show a multifaceted analysis of the factors influencing children’s drinking problems and elucidate the cyclic nature of these factors. Additionally, this study is meaningful in providing practical techniques based on family therapeutic interventions for families with children’s drinking problems.

생성형 AI 이미지를 활용한 내러티브 상담 경험: 미해결 원가족 이슈를 경험한 여성 사례들을 중심으로

Objectives: This study is a multiple case study analyzing the counseling experiences of four women with unresolved family-of-origin issues through narrative therapy using AI image generation. Methods: DALL-E3 was used to convert family-of-origin issues and expectations into images, which were then used as tools for counseling. After completing five sessions of counseling, semi-structured interviews and focus group interviews were conducted. Results: The findings from the qualitative analyses were as follows. First, in the domain of “encountering AI”, AI was found to be an effective tool for helping participants to confront unresolved family-of-origin issues, overcome sadness and regain confidence and agency. Second, in the domain of “dissolution of discourse”, participants' understanding and acceptance of their family-of-origin increased. Third, in the domain of “alternative story”, participants’ current family relationships were improved, and their self-care/self-acceptance abilities were expanded. Conclusion: The potential use of image-generating AI in the family therapy field was discussed.

DIGITAL MENTAL HEALTH: THE FUTURE IS NOW

Over a decade ago, we foresaw the imminent arrival of the digital health era. Yet, it wasn't until the outbreak of the COVID-19 pandemic that this future truly took shape. The pandemic became a catalyst, seamlessly integrating a spectrum of digital tools into clinical practice, fundamentally transforming the way mental health services were delivered. The inclusion of digital health technologies in our arsenal is not merely an addition; it's a revolutionary shift. These tools are pivotal in enhancing care accessibility and significantly augment our capabilities in diagnosis, treatment, and healthcare delivery, transcending national borders. Telemedicine and clinical systems enabled by the Internet are widely accessible and are beginning to affect the dynamics between doctors and patients, with this trend expected to continue in the future. Telemedicine consultations have become so ubiquitous that they are now routinely conducted via broadband Internet systems hosted in the cloud. This has enabled professionals from various fields within mental health (MH), including psychiatrists, psychologists, marriage and family therapists, and career counselors, to offer e-therapy services.

Increasing Transgender Acceptance in Religious Families: A Pilot Study of Manualized Strategic Family Therapy

ABSTRACT This pilot study explores strategies to increase transgender acceptance within religious families by applying a brief, manualized treatment approach. The research uniquely integrates Haley’s Model for Effective Family Therapy with principles of cultural humility to address the specific challenges associated with transgender identity in a conservative Baptist context. Employing a clinical case study approach, this research combines qualitative and quantitative methods to evaluate the implementation of manualized therapeutic strategies. The study focuses on adapting Haley’s model to enhance family dynamics and promote acceptance while respecting the family’s cultural and religious context. Quantitative data show significant improvements across both the Closeness Scale and the Brief COPE Scale. Family cohesion, overall coping, problem-focused coping, and emotional regulation strategies substantial increased. Qualitative findings further validated these improvements, highlighting enhanced family dynamics and transgender acceptance. These effects were sustained for at least three months post-intervention, indicating lasting positive impacts on family dynamics and coping. This pilot study provides novel contributions by demonstrating how Haley’s Model, adapted with cultural humility, can effectively enhance transgender acceptance within a religiously conservative family system. It underscores the value of culturally respectful and systematic approaches in therapy and highlights the need for further research to explore the long-term effects and broader applicability of these interventions in diverse contexts.

Assessment of the Quality of Life and Family Function in Attention Deficit Hyperactivity Disorder Caregivers in Al-Ahsa, Saudi Arabia.

Background Attention deficit hyperactivity disorder (ADHD) is the most prevalent neurobehavioral disorder in children and teenagers. The condition is debilitating, affecting numerous cognitive and behavioral processes and leading to substantial long-term consequences. Affected individuals, their families, and society as a whole bear a heavy functional, psychological, and financial cost. Aim The objective of this study was to evaluate the quality of life (QOL) among parents of children with ADHD diagnoses, as well as the burden and level of dysfunction in the family. Additionally, to ascertain the sociodemographic factors that influence these issues. Methods This cross-sectional study used an online survey to collect data from caregivers of children with a confirmed diagnosis of any type of ADHD who were exhibiting symptoms before the age of seven, speaking Arabic fluently and consented to take part in the study. The Arabic version questionnaire of the World Health Organization Quality of Life instrument (WHOQOL-BREF) was used to assess the QOL, and the Zarit Burden Interview questionnaire was employed to assess the degree of the experienced burden. Participants were recruited by a systematic random sampling method. Results A total of 103 ADHD caregivers were included in the study. A total of 89 out of 103 (86.4%) participants reported having various degrees of burden. There was a significant relation between the marital status of the caregiver and the degree of burden (p=0.024). Divorced caregivers were (4, 57.1%) severely burdened. Ninety out of 103 participants (87.4%) reported having dysfunctional families, and the majority of them (60, 60.1%) reported moderate family dysfunction. All quality-of-life domains were negatively impacted, with the environmental domain experiencing the most disruption. The overall four subdomains of QOLdid not differ significantly with various sociodemographic characteristics. Conclusion There was a high prevalence of burden and family dysfunctionamong caregivers of ADHD children. Marital status was associated with a significant impact on the level of burden.In addition, there was a detrimental influence on every aspect of quality of life, with the environmental domain suffering the most. It is important to take into account family therapy and other interventions that strengthen caregivers' and families' relationships.

PSYCHOLOGICAL FAILURE WITH PATIENTS IN A STATE OF PSYCHOTRAUMA: FAMILY CONSTALKING ACCORDING TO HELLINGER

The method of family constellations was developed in the 90s by the former missionary Bert Hellinger and combined some elements of well-established family therapy. The leading questions of this article, formulated mainly from the ideas set out in Hellinger's works, are the following: what is the method of constellations today, what risks for patients actually exist and what should be the attitude of scientific psychotherapy to the method of constellations? The dynamics of the method and the risks associated with it are illustrated using examples from Hellinger's works. Cases of trauma are recorded. Actions for introducing the technique of constellations into professional circulation are considered. Conclusion: the method of constellations has high risks for all patients with serious psychological problems, especially for patients with psychological trauma. An additional problem is that it is difficult to assume whether a constellation specialist uses the dangerous elements practiced by Hellinger or not. So, if a psychotherapist who adheres to a scientific paradigm wants to integrate some elements of constellation techniques, then it is necessary to find a new term, not loaded with “Helenghian” connotations, and think over a way to protect against retraumatization.

De-stigmatizing marriage and family therapy for those justice- involved

ABSTRACT Widespread misconceptions surrounding incarceration and its intersection with mental health negatively impact the reentry population, particularly through the use of stigmatizing language, which impedes successful reintegration into society. This stigmatization often leads to maladaptive behaviors or recidivism among returning citizens. It is imperative that Marriage and Family Therapists (MFTs) and correctional staff expand their cultural awareness when working with this population to avoid perpetuating harmful stereotypes. This paper examines the challenges faced by returning citizens and their families, emphasizing the detrimental effects of the current gaps in awareness and the urgent need to combat stigma. This paper proposes actionable steps for policymakers, including the integration of comprehensive services for incarcerated individuals, enhanced psychoeducation and training for MFTs, and thorough mental health evaluations and classifications. These interventions aim to improve outcomes for individuals reentering society.

Navigating Transnational Separation and Reunification: Resilience in Low-Income Chinese Immigrant Mothers

AbstractThe present study examines the experience of low-income Chinese immigrant mothers managing the reunification process with their young children after a prolonged transnational separation—either due to reverse migration separation (children born in the US but sent to live in China, then returned to the US later) or serial migration (the mother came to the US first, and the children followed years later). Grounded in a feminist family therapy and resilience framework, this qualitative study aims to understand the mothers’ experience through a strength-based perspective and a cultural lens. A phenomenological approach was used in this study to obtain qualitative data from interviews with nine Chinese immigrant mothers. Data were analyzed using the deductive approach of thematic analysis. Results highlighted mothers’ resilience in providing for the families’ needs, utilizing familial and community support, and their strategies to overcome adversities and parenting challenges. The participants demonstrate motivation to improve their children’s well-being by utilizing a range of public, school, and community resources and support from other Chinese parents. Areas where these mothers still needed support were also identified. Lastly, implications for clinical service with Chinese immigrant families are discussed.

Core Mental Health Clinician Capacity and Use Rates in the US Military

Active duty service members have higher mental health stress and cannot choose where to live. It is imperative to understand how geographic access may be associated with their ability to obtain mental health treatment and how the COVID-19 pandemic was associated with these patterns. To identify changes in the prevalence and intensity of mental health care use when service members experienced changes in core mental health clinician (defined to include psychiatrists, psychiatric nurse practitioners, clinical psychologists and social workers, and marriage and family therapists) capacity in their communities and whether patterns changed from before to after the onset of the COVID-19 pandemic. This retrospective cohort study of the active duty population between January 1, 2016, and December 31, 2022, was conducted using individual fixed-effects models to estimate changes in the probability of mental health care visits and visit volume when a person moved across communities with adequate core mental health clinician capacity (≥1 clinician/6000 beneficiaries), shortage areas (<1 clinician/6000 beneficiaries), and areas with 0 clinicians within a 30-minute drive time. All US active duty service members stationed in the continental US, Hawaii, and Alaska were included. Data were analyzed from January through July 2024. The first set of outcomes captured the probability of making at least 1 mental health care visit in a given quarter; the second set of outcomes captured the intensity of visits (ie, the number of visits log transformed). This study included 33 039 840 quarterly observations representing 2 461 911 unique active duty service members from the Army, Navy, Marines, and Air Force (1 959 110 observations among Asian or Pacific Islander [5.9%], 5 309 276 observations among Black [16.1%], 5 287 168 observations among Hispanic [16.0%], and 18 739 827 observations among White [56.7%] individuals; 27 473 563 observations among males [83.2%]; mean [SD] age, 28.20 [7.78] years). When an active duty service member moved from a community with adequate capacity at military treatment facilities to one with 0 clinicians within a 30-minute drive, the probability of a mental health visit to any clinician decreased by 1.13 percentage points (95% CI, -1.21 to -1.05 percentage points; equivalent to a 11.6% relative decrease) and the intensity of total visits was reduced by 7.7% (95% CI, -9.0% to -6.5%). The gap increased from before to after the onset of the COVID-19 pandemic, from 8.5% (equivalent to -0.82 percentage points [95% CI, -0.92 to -0.73 percentage points]) to 16.2% (equivalent to -1.58 percentage points [95% CI, -1.70 to -1.46 percentage points]) in the probability of visiting any clinician type for mental health. In this study, active duty personnel assigned to locations without core military mental health clinicians within a 30-minute drive time were less likely to obtain mental health care and had fewer mental health care visits than those in communities with adequate military mental health capacity even if there was adequate coverage from the civilian sector. The care disparity increased after the onset of the COVID-19 pandemic.

Revalidating the religious/spiritually integrated practice assessment scale for educators across four mental health disciplines

ABSTRACT This paper describes the validation of the Religious/Spiritually Integrated Practice Assessment Scale for Educators (RSIPAS-EDU) with a diverse sample of faculty in social work, counseling, marriage and family therapy, and psychology. Full-time faculty at accredited graduate schools across disciplines were invited to participate in an online survey that included the RSIPAS-EDU, and 1,742 completed it. Results support the RSIPAS-EDU as a reliable and valid tool to assess mental health educators’ self-efficacy, attitudes, perceived feasibility, behaviors, and overall orientation toward training students to integrate clients’ religion/spirituality in treatment, and identify faculty development needs. Implications and recommendations for future studies are discussed.

Adaptation of the socioecological model to address disparities in engagement of Black men in prostate cancer genetic testing

BackgroundBlack men consistently have higher rates of prostate cancer (PCA)- related mortality. Advances in PCA treatment, screening, and hereditary cancer assessment center around germline testing (GT). Of concern is the significant under-engagement of Black males in PCA GT, limiting the benefit of precision therapy and tailored cancer screening despite longstanding awareness of these disparities. To address these critical disparities, the Socioecological Model (SEM) was employed to develop comprehensive recommendations to overcome barriers and implement equitable strategies to engage Black males in PCA GT.MethodsClinical/research experts, national organization leaders, and community stakeholders spanning multiple regions in US and Africa participated in developing a framework for equity in PCA GT grounded in the SEM. A novel mixed-methods approach was employed to generate key areas to be addressed and informed statements for consensus consideration utilizing the modified Delphi model. Statements achieving strong consensus (> =75% agreement) were included in final equity frameworks addressing clinical/community engagement and research engagement.ResultsAll societal levels of the SEM (interpersonal, institutional, community, and policy/advocacy) must deliver information about PCA GT to Black males that address benefits/limitations, clinical impact, hereditary cancer implications, with acknowledgment of mistrust (mean scores [MS] 4.57-5.00). Interpersonal strategies for information delivery included engagement of family/friends/peers/Black role models to improve education/awareness and overcome mistrust (MS 4.65-5.00). Institutional strategies included diversifying clinical, research, and educational programs and integrating community liaisons into healthcare institutions (MS 4.57-5.00). Community strategies included partnerships with healthcare institutions and visibility of healthcare providers/researchers at community events (MS 4.65–4.91). Policy/advocacy included improving partnerships between advocacy and healthcare/community organizations while protecting patient benefits (MS 4.57-5.00). Media strategies were endorsed for the first time at every level (MS 4.56-5.00).ConclusionThe SEM-based equity frameworks proposed provide the first multidisciplinary strategies dedicated to increase engagement of Black males in PCA GT, which are critical to reduce disparities in PCA-mortality through informing tailored screening, targeted therapy, and cascade testing in families.

Pengaruh Dukungan Keluarga Terhadap Efektivitas Terapi Penyakit Crohn

This study examines the impact of family support on the effectiveness of Crohn's disease therapy through a meta-analysis of 18 studies involving 5,876 patients. The analysis reveals a significant positive effect (Hedges' g = 0.58, 95% CI [0.42, 0.74], p &lt; .001) of family support on various therapeutic outcomes. The strongest effect was observed in the dimensions of quality of life (g = 0.67, 95% CI [0.48, 0.86]) and clinical remission (OR = 2.14, 95% CI [1.68, 2.73]). Furthermore, emotional support was found to have the largest effect (g = 0.63, 95% CI [0.45, 0.81]) compared to other types of family support. Mediation analysis indicated that medication adherence (indirect effect = 0.15, 95% CI [0.08, 0.22]), stress reduction (0.12, 95% CI [0.05, 0.19]), and increased self-efficacy (0.09, 95% CI [0.03, 0.15]) were significant mediators in the relationship between family support and Crohn's disease treatment efficacy. Additionally, a stronger effect of family support was observed in patients with more severe disease (Q = 4.82, p = .028) and samples with a higher proportion of females (? = 0.012, p = .03). These findings extend the work of Sewitch et al. (2001) and Moradkhani et al. (2013) by providing a more precise quantification of the effects of family support and identifying several key moderators. Unlike Trindade et al. (2017), this study consistently found a positive effect of family support on Crohn's disease therapy. The novelty of this research lies in identifying specific mechanisms and moderating factors affecting the relationship between family support and therapy effectiveness, offering a deeper understanding of the complex role of family support in Crohn's disease management.

Communologue in Family Therapy

This article introduces communologue, a process and intervention whose aim is to create safe conversation and deep connecting dialogue within groups and between groups. Communologue originated after 9/11 from the Imago Dialogue intervention developed by Harville Hendrix and Helen LaKelly Hunt's Imago Relationship Therapy in addition to other dialogue and communication experts. This article presents the history and framework as well as a detailed description of the communologue intervention, and its application in family therapy. Special attention is given to the role of the therapist. The connection to the dialogical approach to family therapy and the difference between communologue's specific way of mirroring and active listening are also highlighted. A case study is presented which illustrates the profound ways in which working with a family using communologue can create safety, foster connection, and alter the family dynamics. Implications of communologue and limitations are discussed.

The family alliance as a facilitator of therapeutic change in systemic relational psychotherapy for borderline personality disorder: A case study.

Managing the Therapeutic Alliance is often complex when it comes to the treatment of borderline personality disorder (BPD), but the alliance is crucial for the success of the therapy. Combined individual and family interventions have been shown to be very useful in treating of these cases. This study has two objectives. First, to describe how the family therapeutic alliance facilitates therapeutic change through family psychotherapy for families with a member diagnosed with BPD. Second, to analyze how the therapeutic change achieved through combined individual and family systemic relational psychotherapy affects the individual functioning of the patient with BPD. This single case study used the System of Observation of Family Therapy Alliances (SOFTA-o) to analyze the therapeutic alliance, along with two semi-structured clinical interviews, one at the beginning and one at the end of therapy. Results show a dynamic and positive evolution of the therapeutic alliance throughout the therapeutic process and how this alliance facilitated therapeutic change, both reducing the symptomatology of the patient with BPD and improving family communication and functioning. Results contribute to highlighting the importance of including family therapy as an intervention unit in protocols for patients with BPD.

The Impact of Paternal Closeness and Familial Incarceration on the Self-Esteem of Black Adolescents

Background:Racially minoritized individuals make up the majority of the incarcerated population. The incarceration of a family member has lasting effects on family dynamics, particularly impacting the lives of adolescents. There is a need to understand how these experiences affect adolescent self-esteem and the role of family boundaries.Objective:To examine the impact of familial incarceration on adolescent self-reported self-esteem and the moderating role of boundaries between adolescents and their fathers, using structural family therapy as a guiding framework.Methods:The study utilized data from the 2016 wave of the National Longitudinal Survey of Youth-Children and Young Adults (NLSY-CYA), with a sample size of 341 adolescents. Simple linear and hierarchical regressions were conducted to assess the relationships between familial incarceration, perceived parental closeness, and adolescent self-esteem.Findings:Regression analysis revealed that having an incarcerated family member and lower perceived parental closeness were significantly associated with reduced self-esteem in adolescents. Additionally, closeness to fathers did not act as a protective factor in mitigating the negative impact of familial incarceration on adolescent self-esteem.Conclusions:The findings indicate that while familial incarceration and perceived parental closeness negatively impact adolescent self-esteem, closeness to fathers does not serve as a buffer. These results suggest that practitioners should explore alternative protective factors to support adolescents' self-esteem following familial incarceration.

Sibling relationships: Considerations for family therapy

Siblings are frequently overlooked as an essential focus in family‐based interventions with children. And yet, 80–85% of children worldwide have at least one sibling (Campion Barr &amp; Killeron, 2015). Some have suggested that sibling relationships are a prototype for peer relationships in childhood and adulthood. This makes intuitive sense when one considers the arena within which siblings grow and mature together, with the dynamics involving strong attachments, cooperation, and rivalry and conflict. For instance, a positive sibling relationship can provide emotional support and a sense of security, while a negative relationship can lead to increased stress and anxiety.