Family Therapy Research Articles

Long-term cost-utility analysis of family therapy vs. treatment as usual for young people seen after self-harm

BackgroundThe joint evidence of the cost and the effectiveness of family-based therapies is modest.ObjectiveTo study the cost-effectiveness of family therapy (FT) versus treatment-as-usual (TAU) for young people seen after self-harm combining data from an 18-month trial and hospital records up to 60-month from randomisation.MethodsWe estimate the cost-effectiveness of FT compared to TAU over 5 years using a quasi-Markov state model based on self-harm hospitalisations where probabilities of belonging in a state are directly estimated from hospital data. The primary outcome is quality-adjusted life years (QALY). Cost perspective is NHS and PSS and includes treatment costs, health care use, and hospital attendances whether it is for self-harm or not. Incremental cost-effectiveness ratios are calculated and deterministic and probabilistic sensitivity analyses are conducted.ResultsBoth trial arms show a significant decrease in hospitalisations over the 60-month follow-up. In the base case scenario, FT participants incur higher costs (mean +£1,693) and negative incremental QALYs (-0.01) than TAU patients. The associated ICER at 5 years is dominated and the incremental health benefit at the £30,000 per QALY threshold is -0.067. Probabilistic Sensitivity Analysis finds the probability that FT is cost-effective is around 3 − 2% up to a maximum willingness to pay of £50,000 per QALY. This suggest that the extension of the data to 60 months show no difference in effectiveness between treatments.ConclusionWhilst extended trial follow-up from routinely collected statistics is useful to improve the modelling of longer-term cost-effectiveness, FT is not cost-effective relative to TAU and dominated in a cost-utility analysis.

Evaluating Readmission Rates for a Statewide In-Home Ecosystemic Family-Based Treatment Program for Youth with Serious Emotional Disturbance.

Family Based Mental Health Services (FBMHS) with an embedded clinical model, Ecosystemic Structural Family Therapy, is an intervention designed for youth with a serious emotional disturbance (SED) who are at risk of out-of-home placement. The current evaluation examines the association between receipt of FBMHS and rates of out-of-home and community-based care during and after an episode of FBMHS. We identified 25,016 Medicaid-enrolled youth ages 3 to 17 years with receipt of a new FBMHS episode from 1/1/2015 to 6/30/2021. 14% of youth received out-of-home services. Rates of out-of-home service decreased during receipt of FBMHS (14.25-6.98%, p < .0001) and remained lower 6 months following discharge (to 6.95%, p < .0001). Short and longer doses of service were both associated with decreased rates of out-of-home services. FBMHS has been scaled across a large geographic area and is associated with lower rates of out-of-home placement for youth with SED.

Childhood Trauma and Relationship Satisfaction in Married Turkish Individuals: Mediating the Role of Attachment Injuries

This study examined the effects of attachment injuries on relationship satisfaction in married individuals. The study participants comprised 346 married individuals selected using the convenience sampling method. Data were analyzed using SPSS 22 and AMOS 23 programs. The fit values of the model established in this study were excellent. A significant and negative relationship was observed between the predictor variables and predicted variables in the correlation analysis. The results indicated that childhood trauma negatively predicted relationship satisfaction and attachment injuries mediated the relationship between childhood trauma and relationship satisfaction. Based on these results, it is recommended that family therapists consider the concepts of attachment injuries and emotion-focused couple therapy to intervene in marital problems.

To perturb, not to caress—Systemic family therapy between disambiguation and contingency

ZusammenfassungDer aktuelle Zeitgeist ist teils gekennzeichnet von Polarisierung und Kommunikationsverweigerung. In digitalen Sozialräumen zeigt sich insbesondere, welche Bandbreite an festen Überzeugungen genährt werden kann, die dann immer wieder aufeinanderprallen und zu Vorwürfen und Isolation führen können. Der Prozess AEye mit der Methodik OO7 setzt an unterschiedlichen Orientierungsbedürfnissen an, die in einem systemischen Kontakt – und Moderationsprozess therapeutisch genutzt werden können. Anhand der Identifikation eines aktuell präferierten Orientierungsmusters wird die Möglichkeit für systemische Familientherapeut:innen illustriert, den Blick der Kontaktpersonen auf momentan ausgelassene Orientierungsmöglichkeiten zu weiten. In einem wohldosierten Oszillationsprozess kann diese Voraussetzung für die neuerliche Ankopplung isolierter Personen erreicht werden. Therapeut:innen werden ermutigt, mit ihrem Gegenüber in Schwingung zu gehen, um dann eine geeignete Amplitude und Frequenz zur Einführung unterschiedsbildender Denkmuster zu wählen, welche Klient:innenseitig den selbstregulativen Anpassungsprozess moderiert.

Of Bombs and Bonds: Healing the War-Fractured Internally Displaced Families through Therapy

The article examines the relationship dynamics among families who were uprooted from their traditional communities because of conflict in Marawi City in the southern Philippines. The study specifically explores the areas of family communication, family intimacy, and family conflict domains in households of internally displaced persons (IDPs). Data were drawn from 266 IDP marital couples through an assisted survey. Through statistical comparisons, the study was able to establish that the frequency and quality of communication and intimacy patterns fell while family conflict increased. A t-Test also indicates the decreased trajectory of the quality of familial relationship in displacement compared to prior displacement. These results underpin the fact that war harms family harmony. The study argues that the government, through their social welfare offices, being at the forefront of social care intervention, should consider providing family therapy as a specific assistance to IDPs. More than ensuring a strengthened family bond, the benefit of undergoing family therapy is vital because it may have implications for the pace by which IDP families build back better. Future studies may explore the effectiveness of family therapy intervention to strengthen its place in the social services arena in the context of internal displacement.

Reconnecting systemic family therapy: How family therapy training can attend to the ecosystem and climate emergency, recommendations from a Delphi survey

AbstractWe are facing devastating effects of the climate emergency and systemic environmental breakdown. These impact on mental health and wellbeing. Family therapy has only marginally engaged with these crises and the relationship between people and ecosystem. This Delphi survey identifies key elements to include in family therapy training to attend to the ecosystem and the climate and ecological emergencies. Participants generated ninety‐six statements that were clustered into six overarching ‘topic areas’ (theories, orientations, schools, integrations/transformations, methods, and techniques). There were sixty‐six statements agreed at a high level of consensus and seventeen with a moderate level of consensus, while there was no consensus over the remaining thirteen items. All participants opted to suggest references, which form a reading list to accompany these ideas.

Effects of sexual orientation-based prejudice and discrimination in family of origin on depressive symptoms and life satisfaction in a Chinese sample: Reciprocal and authoritarian filial piety as moderators.

Experiencing prejudice and discrimination from family has been found to be positively associated with mental health problems among sexual minorities. Emerging evidence also shows the value of contextualizing the internalization of minority stress by considering individual cultural factors, such as filial piety. We examined whether authoritarian filial piety (AFP) and reciprocal filial piety (RFP) moderated the link between distal stressors in one's family and mental health outcomes. A total of 362 (56.9% male; age: M = 24.55, SD = 6.60) Chinese lesbian, gay, bisexual, queer/questioning, and other non-heterosexual (LGBQ+) individuals participated in this study. They provided demographic information and completed a battery of measures for AFP and RFP, sexual orientation-based prejudice and discrimination in family of origin (SOPDF), depressive symptoms, and life satisfaction. Structural equation modeling results showed that SOPDF had a positive and negative link with depressive symptoms and life satisfaction, respectively. In addition, we identified AFP and RFP as significant moderators for the association between SOPDF and depressive symptoms, and the association between SOPDF and life satisfaction, respectively. Specifically, the positive effect of SOPDF on depressive symptoms was greater for participants with higher levels of AFP; the negative effect of SOPDF on life satisfaction was greater for participants who endorsed higher levels of RFP. Our findings corroborated past studies' conclusion about the detrimental impact of familial sexual stigma on LGBQ+ people's mental health. Furthermore, such impact on negative and positive mental health outcomes are respectively conditioned by the degree to which LGBQ+ individuals endorse AFP and RFP. These findings underscore the importance for therapists who endorse family therapy to help LGBQ+ clients navigate familial sexual stigma and consider the role of filial piety beliefs in shaping the impact of familial sexual stigma on these clients' mental health.

Comparative efficacy of psychological interventions on anxiety and depression in patients with cancer: A systematic review and network meta-analysis.

Numerous studies have demonstrated that psychological interventions are effective in alleviating anxiety and depression in patients with cancer. However, the optimal psychological intervention to alleviate anxiety and depression in patients with cancer remains unknown. This study was carried out to compare and rank the comparative effectiveness of various psychological interventions on anxiety and depression in patients with cancer. Databases, namely PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, CNKI, WanFang, VIP and CBM were systematically searched from their inception dates to December 2023 for randomized controlled trials of psychological interventions for anxiety and depression in patients with cancer. Utilizing the Cochrane Review Manager 5.4, we evaluated the risk of bias in the studies included in the current study based on the Cochrane Handbook 5.1.0 Methodological Quality Evaluation Criteria. The NMA was conducted using STATA 15.0. This study did not involve human participants and therefore did not require ethical approval. Thirty-one randomized controlled trials involving 3471 participants were included. MT [SMD = 1.35, 95% CI (0.76, 1.93)] and cognitive behavioral therapy (CBT) [SMD = 0.97, 95% CI (0.53, 1.42)] were superior to usual care in alleviating anxiety. Besides, interpersonal psychotherapy (IPT) [SMD = 1.17, 95% CI (0.06, 2.28)], CBT [SMD = 0.97, 95 % CI (0.63, 1.30)], and MT [SMD = 0.93, 95% CI (0.35, 1.50)] were superior to usual care in alleviating depression. In addition, CBT was superior to family therapy in alleviating depression [SMD = 0.73, 95% CI (0.08, 1.38)]. The MT, CBT, and IPT ranked in the top three in alleviating anxiety, while IPT, CBT, and MT ranked in the top three in alleviating depression. MT and IPT would be a more appropriate option in alleviating anxiety and depression in patients with cancer, respectively. This study also suggested that CBT had a significant effect in alleviating negative emotions in patients with cancer. However, the results need to be validated by high-quality and large-sample studies.

Parenting a child with ‘Diabulimia’: A systemic interpretative phenomenological analysis

AbstractThe aim of this paper is to examine the experiences and views of parents whose child lived with type 1 diabetes (T1DM) and eating disorder (ED), specifically ‘diabulimia’ and the professional support offered to them. Interpretative phenomenological analysis (IPA) was employed as a methodology to explore the experience of three parents (mothers) living in the United Kingdom, regarding their chronically ill children. Four themes emerged from the analysis: battling, blaming, surviving and loss. These were interpreted through the lens of systemic theory. Within the framework of the results and the discussion, further research and the provision of systemic family therapy for children, parents and families in both paediatric and adolescent‐to‐adult transition diabetes clinics is recommended.

Outpatient treatment of children and adolescents using emotion-focused family therapy (EFFT) caregiver workshops: A pre- to postintervention evaluation.

Outpatient treatment of children and adolescents using emotion-focused family therapy (EFFT) caregiver workshops: A pre- to postintervention evaluation.

The relationship between perceived family support and subclinical positive symptoms of psychosis among Black college students.

Black individuals in the Unites States endure compounded and unique experiences of discrimination and structural racism that may not be as overtly evident in other countries. These distinctive forms of discrimination and racism can impact the mental health of Black individuals in the Unites States, in this case, their risk for psychosis. Adolescence and early adulthood are vulnerable periods in life where mental illness typically begins to manifest. Understanding the factors contributing to an increased likelihood of specific mental illnesses, such as psychosis, among youth in these vulnerable periods can inform intervention development. This is particularly important for those from minoritized backgrounds Unites States; this group is especially important to study given that Black American youth tend to experience higher psychosis rates and different symptom presentations than non-Black groups. This study examined the associations between perceived family support, a critical environmental factor known to be associated with full-psychosis, and attenuated positive symptoms and distress levels in a sample of 155 Black students from a Historically Black College and University (HBCU). Participants completed the Prodromal Questionnaire-Brief that assessed psychosis risk and the Family Environment Scale that assessed three dimensions of family support (family cohesion, expressiveness, and conflict). Positive symptom intensity (r = .30, p < .001) and distress (r = .34, p < .001) were significantly associated with higher family conflict for Black individuals in the Unites States. The findings inform novel intervention targets for psychoeducation and family therapy that have potential to reduce psychosis risk.

Does Person-of-the-Therapist Training (POTT) Promote Self-Caring Attitude for Trainees in a Chinese Society? A Directed Content Analysis at a University in Taiwan

ABSTRACT Literature has demonstrated the importance of self-care for marriage and family therapists (MFTs) and trainees. However, little research elaborated on how we can promote self-care in therapist training and education, especially in Chinese societies. This study focused on the self-caring attitude graduate students reported after enrolling in a Person-of-the-Therapist Training (POTT) class taught at a university in Taiwan. In this class, students were required to write a final paper to reflect on the personal and professional changes they had experienced during this class and to provide feedback about the class. These de-identified final papers from research participating students were the source of the qualitative data. Using directed content analysis, the author found that the students’ self-caring attitude improved after the course. Cultural and contextual factors that might have influenced participants’ self-caring attitude during this process are discussed. Clinical and training recommendations for educators are included as well.

TIAP: an observational procedure for assessing family relationships: a clinical case from the parenting evaluation context.

TIAP is an observational procedure to assess family functioning detecting simultaneously the role of each participant and the interdependence of relational behaviors. In particular, the procedure requires family members to play according to different interactive configurations (parent1-children; parent2-children, all together, children and parents as separate units) and therefore different microtransitions from one configuration to another. As such, the procedure allows to study how family members coordinate to maintain stability, promote change, and encourage members to explore different interactive configurations within the family system. TIAP has been validated through several studies conducted with different non-clinical groups of families that have highlighted the salient aspects of family functioning, and significant correlations with variables external to the family system, such as children's social-emotional competence in the educational context. This paper focuses on the use of TIAP in the contexts of assessing parental competence. Specifically, the article aims to describe, through the reference to a clinical case, the results emerged from a study conducted with 33 families involved in a parenting assessment process. The study is part of a broader collaborative project between the Child and Adolescent Neuropsychiatry Clinic of the Italian National Health Service in Parma, the University of Parma, and the Bologna Family Therapy Center. TIAP was administered to all the families involved as a complement to other tools routinely used for all cases handled by the professionals of the clinic. The coding system includes different indices. Some analyze the interactive family modes: family coordination (mutual attention and responsiveness), the responses to potentials for change (disregard, absorption, amplification), and intra-familiar exploration. Other indices concern the quality of the interactions: the relational triadic dynamic of microtransition (detaching-entrusting-welcoming-joining) and the consistency/inconsistency of the communication channels. The results highlighted how TIAP makes it possible to identify the specific interactive modalities of the different members and their interdependence and reciprocity, favoring the identification of both family weaknesses and family resources, including the children's contribution. Furthermore, the general data trend showed that TIAP indices detect some important prognostic elements capable of guiding the court's decisions.

Power dynamics in couple relationships: A review and applications for systemic family therapists.

Power dynamics, generally defined as the patterns of partners enacting or resisting influence, are inherent in all relationships. Power structures and processes play a role in people's perceptions of themselves and others, their feelings and emotions, and both their implicit and explicit behaviors. As such, understanding power dynamics is crucial for fully conceptualizing and intervening within relationships. Although power was not always given high priority in many of the early systemic family therapy models, that has changed over the years, with scholars working to address how power is manifested in relationships, how power imbalances affect relationships, and how power can be addressed more explicitly in treatment. Nonetheless, there is much additional work needed to ensure that systemic therapists have an appropriate depth of understanding regarding power dynamics to fully recognize their manifestations in relationships and then intervene appropriately. To help in these efforts, this paper aims to synthesize relational power research into a more complete description of what power is and how it is enacted in couple relationships. To do this, we introduce relevant perspectives of power not fully integrated with family therapy theories. Overall, we provide a brief history of power-oriented research in the fields of family therapy, outline couple research regarding the sources of power that can inform therapeutic case conceptualizations and interventions, describe how power is addressed in specific couple therapy models, and highlight some important clinical applications that can help systemic therapists more fully address power.

Social Media Insecurity and Intimate Partner Violence: Drug Use As an Escape Route

ABSTRACT The study examined social media insecurity and intimate partner violence as determinants of drug use. This prospective cohort study purposively recruited 387 married population with 54 of them re-enrolled in intervention therapy. Multilinear regressions and paired sample t-test were employed. Social media insecurity was an independent predictor of drug use; the higher the level of social media insecurity, the more participants used drugs whereas intimate partner violence did not predict drug use. The paired t-test showed a significant reduction in drug use after the eclectic therapy, which involved integrative coping skills, drug counseling/education and family therapy, aimed at reducing harms.

Family dynamics in the context of elder family financial exploitation: Application of qualitative genogram analysis

AbstractObjectiveThis study examined family dynamics that are common in families experiencing elder family financial exploitation (EFFE) using an innovative analytical protocol, qualitative genogram analysis.BackgroundEFFE is a form of elder abuse that affects many older adults and their families. Individual factors associated with EFFE have been examined, but what is missing is a greater focus on the complex family dynamics that contribute to this violation of older family members.MethodUsing qualitative genogram analysis (QGA), a three‐step analytical protocol using family systems theory as a foundation, this study identified key relationship patterns commonly found in families where exploitation had occurred. Family genograms generated from 20 interviewees representing 20 families that reportedly experienced EFFE were used to identify common family dynamic themes.ResultsUsing QGA, we identified four relational dynamic themes across families: distance and closeness, triangulation, power and dominance, and partner influence.ConclusionThese themes illustrate that families experiencing EFFE have several similar relational dynamics, which may have contributed to creating contexts that made older family members more vulnerable to financial exploitation.ImplicationsThe findings of this study provide important indicators for practitioners (e.g., family therapists, family life educators, family attorneys) and policymakers in supporting older family members in making better financial decisions later in life.

Problematic Internet Use among Adolescents: A Review of Influencing Factors and Coping Strategies

Currently, the Internet is deeply embedded in human life, and adolescent problematic Internet use has become a global public health challenge. This review explores the influencing factors and coping strategies of adolescent problematic Internet use. Theoretical models such as I-PACE, Internet Compensation Theory, Attachment Theory, and Socio-Psycho-Physiological Model are involved. Macro to micro factors is analyzed: internet anonymity, family and school environment, personality, self-control and emotional problems. Point out the physiological, psychological, and behavioral effects of problematic use. Propose prevention and intervention strategies such as cognitive-behavioral therapy, family therapy, and exercise interventions to support adolescents in overcoming problematic Internet use challenges.

The impact of mindfulness therapy combined with mentalization-based family therapy on suicidal ideation in adolescents with depressive disorder: randomized intervention study

BackgroundAdolescents with depression who engage in non-suicidal self harming behaviors are more likely to adopt negative coping strategies when faced with negative events. Therefore, these patients should be introduced to positive coping strategies. Evidences have showed that mindfulness-based interventions can positively impact the psychology of patients with mental disorders. This study was to explore the impact of a combination of mindfulness therapy and mentalization-based family therapy (MBFT) on suicidal ideation in adolescents with depressive disorder.MethodsEighty adolescent patients with depression and suicidal ideation admitted to our hospital from September 2021 to February 2022 were selected as subjects. They were divided into a control group and a study group using the random number table method, with each group comprising 40 subjects. The control group received MBFT, whereas the study group received both mindfulness therapy and MBFT. The psychological status and suicidal ideations of the two groups were compared before and after the intervention.ResultsThe psychological health scores of both groups of patients were lower after the intervention, with the scores of the study group being lower than those of the control group (P < 0.05). The scores on the suicidal ideation scales for both groups were lower after intervention, and the study group scored lower than the control group (P < 0.05). The absolute values of the differences in psychological health scale scores and suicidal ideation scale scores before and after the intervention were higher in the study group than in the control group (P < 0.05).ConclusionThe combination of mindfulness therapy and MBFT can improve the psychological condition of adolescents with depression, reduce their suicidal ideations, and help them develop a healthy and positive outlook toward life, making this method worthy of clinical recommendation.

Linguistic Analysis of Nonsuicidal Self-Injury Reddit Posts: Implications for Family Therapy

Nonsuicidal self-injury (NSSI) is a growing phenomenon, yet there is still a limited understanding of the behavior, intent behind the behavior and what individuals themselves say about their behavior. This study collected pro-NSSI public blog posts from Reddit and analyzed the content linguistically using Linguistic Inquiry and Word Count software, to examine the use of NSSI specific words, linguistic and psychological linguistic properties. The results inform current mental health practices by dispelling myths and providing insight into the inner world of people who engage in NSSI. The linguistic properties found in the analysis reflected the predicted results; authors of pro-NSSI posts used first-person singular pronouns extensively, indicating high levels of mental health distress and isolation. This study demonstrates how understanding the language of self-harm can help inform mental health treatment using family therapy.

Impact of Divorce on Parent-Child Relationships

Purpose: The general objective of this study was to explore the impact of divorce on parent- child relationships. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to the impact of divorce on parent- child relationships. Preliminary empirical review revealed that divorce significantly influenced these dynamics, often leading to challenges in communication, emotional bonding, and co-parenting. Children of divorced parents experienced various emotional and psychological difficulties, such as insecurity and anxiety, with the disruption of family routines exacerbating these issues. However, the consequences varied based on factors like child age, gender, and family functioning. Despite these challenges, many children showed resilience over time, with factors like parental warmth and effective communication buffering the negative effects. Overall, understanding these complexities allowed for the development of strategies to support families during the transition process, promoting positive outcomes for children and families. Unique Contribution to Theory, Practice and Policy: The Attachment theory, Family Systems theory and Social Learning theory may be used to anchor future studies on the impact divorce has on parent- child relationships. By integrating multiple theoretical perspectives such as attachment theory and family systems theory, researchers gained a comprehensive understanding of the complexities surrounding divorce's effects on parent-child relationships. Evidence-based interventions, including parent education programs and family therapy, were recommended to support families during the divorce process. Moreover, policy reforms advocating for the protection of children's rights and access to supportive services were proposed. These recommendations aimed to enhance the well-being of children and families navigating the challenges of divorce, fostering healthier family dynamics and parent-child relationships.