Including Family Therapy Research Articles

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.

From guided self-help to comprehensive ED treatment

IntroductionThe incidence of eating disorders is increasing in Hungary and Central-Eastern Europe. The number of complex/severe cases is also increasing. Accordingly, several new unmet needs of the users and their relatives appear in the clinical care.ObjectivesAs a possible response to these unmet needs, we have introduced a multifaceted care model for eating disorders. To facilitate easily accessible yet effective care close to home, a support programme with an online guided self-help tool and regular consultations with first responder psychiatrists or clinical psychologists has been introduced. For non (or partial) responders, a multi-faceted modular treatment programme has been developed with an individualised combination of different therapeutic approaches, including family therapy, dialectical behaviour therapy (DBT) specific to binge eating disorder and bulimia, CBT and the use of virtual reality as an adjunct treatment. The most severe cases are referred for (also multifaceted) inpatient treatment. In terms of research, we want to focus on the key issues for rapid, cost-effective treatment. Firstly, we want to develop an individual profiling system at the start of therapy to assess which individual combination of modules can produce a rapid therapeutic response. Secondly, we want to identify the active gamechanger elements of therapy that are associated with the greatest change in symptoms.MethodsPatients complete the following questionnaires:-in the guided self-help group: Eating disoreder inventory, (EDI-I), McMaster Family Assessment Device (FAD), Eastin Disorder Diagnostic Scale (EDDS), Eating Behavioral Severity Scale, Eating Disorders Symptom Impact Scale (EDSIS-S)- in DBT groups: Eating Disorder Examination Questionnarie (EDE-Q), Three Factor Eating Questionnaire-R21, Rosenberg Self-Esteem Scale, Patient Health Questionnaire-(PHQ-9), Cognitive Emotion Regulation Questionnaire (CERQ)- in individual therapies: Mini International Neuropsychiatric Interview (MINI) and Structured Clinical Interview for DSM 5- Alternative Model for Personality Disorders (SCIP-5-AMPD), EDI-I., Mentalization Questionnaire (MZQ), Dissociation Questionnaire (DIS-Q), Symptom Checklist-90 (SCL-90), (PHQ-9), Childhood Trauma Questionnaire (CTQ) and Young Parenting Inventory (YPI).ResultsPatient recruitment and therapies are currently underway, the first preliminary results are expected in the spring period.ConclusionsIn order to provide individualized care more effectively, it is important to identify the factors that determine which therapeutic modalities work best for the patient.Disclosure of InterestNone Declared

Review on Clinical Perspective of Multiple Substance use Disorder and its Ayurvedic Management

Background: Substance use disorder (SUD) is a condition in which there is uncontrolled use of a substance despite harmful consequences. Multiple Substance Use Disorders (MSU) include two or more substances taken together or within a short time period, either intentionally or unintentionally. This may lead to problems such as health issues, disability, failure to meet work responsibilities, and difficulties at school and home. Studies have concluded that opiates, cannabis, amphetamines, hallucinogens, inhalants, and benzodiazepines are often used in combination as well. This leads to social, academic, and occupational impairment, along with possible negative health effects. Individuals who abuse one substance are more likely to use other substances as well. Among those aged 12 or older, 61.2 million people (i.e., 21.9% of the population) used illicit drugs in the past year. Objective: To highlight the Ayurvedic clinical perspective in the management of multiple SUDs. Method: In Ayurveda, SUD may be approached by adapting the management principles of madatyaya after assessing the dosha combination as per the clinical presentation. Several combinations useful for the management of the condition, including addiction and withdrawal management, are explained. Ashtanga Lavana, Ajmodarka, Sreekandasava, and Drakshadi Kwatha are some of the medicines used internally to reduce withdrawal symptoms. Panchakarma therapies, along with yoga and Satvavajaya Chikitsa, including family therapy, have a very good outcome in managing substance withdrawal, dependence, and even inpreventing relapse. Results: By adopting the Ayurvedic principles, the outcome of MSU management may be enhanced, and the relapse may also be possible to reduced with the biopsychosocial approach. Conclusion: Evidence-based clinical studies are the need of the hour so as to prove the authenticity of such a clinical perspective explained in Ayurvedic parlance.

The Impact of Anorexia Nervosa and the Basis for Non-Pharmacological Interventions.

Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual's preoccupation with their weight and body structure while denying the severity of their low body weight. Due to the fact that anorexia nervosa is multifaceted and may indicate the coexistence of genetic, social, hormonal, and psychiatric disorders, a description of non-pharmacological interventions can be used to ameliorate or reduce the symptoms of this condition. Consequently, the purpose of the present narrative review is to describe the profile's context in the anorexic person as well as the support they would require from their family and environment. In addition, it is aimed at examining preventative and non-pharmacological interventions, such as nutritional interventions, physical activity interventions, psychological interventions, psychosocial interventions, and physical therapy interventions. To reach the narrative review aims, a critical review was conducted utilizing both primary sources, such as scientific publications, and secondary sources, such as bibliographic indexes, web pages, and databases. Nutritional interventions include nutritional education and an individualized treatment for each patient, physical activity interventions include allowing patients to perform controlled physical activity, psychological interventions include family therapy and evaluation of the existence of other psychological disorders, psychosocial interventions include management of the relationship between the patient and social media and physical therapy interventions include relaxation massages and exercises to relieve pain. All these non-pharmacological interventions need to be individualized based on each patient's needs.

Experiential Family Intervention for Children and Youth

IntroductionReviews suggest that family interventions including family therapy are effective for a range of disorders in youth. Family sculpting is used in different clinical settings to help young patients, their parents and siblings when words are not enough.ObjectivesParticipants will be able to understand the clinical relevance of family sculpting: shifting from discussions about family problems to physical representations of family dynamics and how to apply in their practice.MethodsThere will be a brief overview of the general principle of family sculpting followed by clinical vignettes of patients combined with videos of the intervention. These examples will guide the discussion on how relevant in our clinical work this therapeutic practice may be. This variation on sculpting incorporates theater warmup exercises and therapists joining the family experience.ResultsFamily sculpting captures an immediate picture of the family dynamics that is a therapeutic turning point for families and gives voice to the children. The clinical cases and videos will guide clinicians on how to integrate into their own practice.ConclusionsThis presentation will make possible integrating family sculpting into your own practice, providing an engaging alternative modality for complex cases.DisclosureNo significant relationships.

Socio-Psychological Factors of Compliance of Patients with Schizophrenia

Purpose:analysis of the literature on the influence of socio-psychological factors on the complimentary behavior of patients with schizophrenia.Material:according to the keywords “schizophrenia”, “compliance”, “adherence to treatment”, “awareness of the disease”, “psychological factors”, “social factors”, “psycho-education”, “family therapy”, articles of domestic and foreign authors were selected and studied, devoted to the problem of compliance with schizophrenia patients and published in the last two decades. To compile a literature review, articles in the MedLine/PubMed, eLIBRARY, databases were selected and analyzed, relevant links in the literature lists of the analyzed articles.Discussion:analysis of publications showed that at present, numerous factors have been identified that affect the compliant behavior of schizophrenia patients, among which factors associated with the clinical picture of the disease, cultural and religious characteristics of individuals, medication, the organization of medical care, and many others have been identified. The article most thoroughly discusses the socio-psychological factors of schizophrenia patients’ compliance — the internal picture of the disease, the emotional response of the patient and his relatives to the disease, the therapeutic alliance with specialists of the psychiatric service and a number of other factors. The relationship of the schizophrenia patients’ compliance with their cognitive, emotional and motivational-behavioral spheres of personality was considered.Conclusion:compliance of patients with schizophrenia can improve the combination of drug therapy with psychoeducational work. A psychoeducation program should be available to most of them. Given the influence of relatives on the formation of compliance with schizophrenia patients, it is necessary to include family therapy in treatment and rehabilitation programs of psychiatric institutions.

Whatever Happened to Couples and Family Therapy in Psychiatry?

Whatever Happened to Couples and Family Therapy in Psychiatry?

An Overview of Trauma-Informed Care and Practice for Eating Disorders

ABSTRACTThis article reviews concepts and principles of trauma-informed care and trauma-informed practice for those with eating disorders (EDs). EDs are not universally recognized to be associated with traumatic events, despite substantial research evidence indicating that individuals with EDs report very high rates of childhood maltreatment, other lifetime traumatic events, as well as adverse consequences from trauma. Using national representative samples, higher prevalence rates of PTSD and other trauma-related comorbidities have been reported in those with EDs, particularly those with bulimic symptoms (binge eating and/or purging). Evidence suggests that those prone to develop EDs appear to be especially sensitive to the effects of stress/adversity and have high rates of premorbid anxiety disorders, personality traits, and neuropsychological features that predispose them to PTSD and its symptoms. This article also reviews some of the important principles for treating individuals with EDs comorbid for PTSD and other trauma-related disorders, including the necessity of moving beyond sequential treatment to the development of integrated treatment protocols. Integration of existing evidence-based treatments, including family therapy, cognitive behavioral therapy, dialectical behavior therapy, cognitive processing therapy, prolonged exposure, and eye movement desensitization reprocessing are recommended. Recent research suggests that ED clinicians view integrated treatment for individuals with ED and PTSD as a top priority, yet they have several concerns about administering such a treatment. As trauma-informed care is embraced by all clinicians and treatment programs that assess and treat eating and related disorders, better outcomes are anticipated.

Psychosocial outcomes in a cohort of perinatally HIV-infected adolescents in Western Jamaica

Background: Psychosocial factors interact with adolescent development and affect the ability of HIV-infected adolescents to cope with and adhere to treatment.Aim: To evaluate psychosocial outcomes in perinatally HIV-infected adolescents (PHIVAs) in Western Jamaica after psychosocial intervention.Methods: The Bright Futures Paediatric Symptom Checklist (BF-PSC) was used for psychological screening of PHIVAs in Western Jamaica. Referred patients were evaluated using the Youth version of the Columbia Impairment Scale (CIS). Demographic, laboratory and clinical data obtained between July 2014 and June 2016 were evaluated retrospectively and outcomes were reviewed before and after psychosocial intervention.Results: Sixty PHIVAs were enrolled and 36 (60%) had a positive BF-PSC score that necessitated referral. The BF-PSC correctly identified 89% of patients with impaired psychosocial assessment by CIS scores. Referred patients were less likely to adhere to treatment, to be virologically suppressed or to have a CD4+ count of >500 cells/μl, and were more likely to be in the late teenage group or to be of orphan status. After intervention, the prevalence of viral suppression increased and median viral load decreased. A difference in mean CD4+ cell count was detected before but not after intervention in teenage and orphan groups.Conclusions: The BF-PSC identified at-risk PHIVAs with impaired psychosocial functioning. Increased vulnerability was noted in orphans and older teenagers. Psychosocial interventions (including family therapy) reduced psychosocial impairment and improved virological suppression. Mental health intervention should be instituted to facilitate improved clinical outcomes, autonomy of care and transition to adult care.

Treatment of people at ultra-high risk for psychosis.

Treatment of people at ultra-high risk for psychosis.

EHealth Intervention for Problematic Internet Use (PIU).

Excessive use of the Internet is considered a problematic behaviour by clinicians and researchers. Cognitive behaviour therapy (CBT) has been advocated for a long time as a treatment approach and has been extended to include family therapy in the recent years. As eTherapy (eHealth) has become an important component in the treatment of many mental health problems, it is prudent to explore the current status of the eHealth approach as an intervention option for this problem. This systematic review aims to examine the current development of online intervention programmes for this particular condition. The PRISMA guidelines for systematic reviews and meta-analysis were employed to conduct the search for literature following a systematic and structured approach. Of the 182 articles screened, three satisfied the selection criteria. Information was extracted and analysed systematically for each study and tabulated. All these studies were pilot studies with small sample sizes. Two of these articles aimed to explore the therapeutic efficacy of newly developed online intervention programmes for Internet addiction (IA) and online gaming addiction. The third article described the design and development of an App for smartphone addiction. The results obtained from this review have provided insight into the on-going development of eHealth interventions as well as the health informatics approaches in offering a possible and practical solution to tackle this growing problem.

Costrutti e relazioni Intervista a Harry Procter

H. G. Procter, PhD, Consultant Clinical Psychologist. Harry Procter is Visiting Professor at the University of Hertfordshire, UK. He conducted his doctoral research in the early 1970’s at the Department of Mental Health, University of Bristol, on applying Personal Construct Psychology to family processes and beginning the development of a Systemic Constructivist approach to family therapy. After training as a Clinical Psychologist in Nottingham, he worked in Adult and then Child and Adolescent Mental Health in Somerset before retiring from the NHS in 2004. Currently, he is involved in supervision and teaching in a number of countries and is continuing to develop Constructivist applications to relational and organizational contexts. He has published over 40 papers and chapters covering a variety of topics including family therapy for children and adults with mental health and learning disabilities, schizophrenia, autism, hypnotherapy, reflective practice, formulation and the philosophical background to his approach. He has edited two volumes of papers of Milton H. Erickson for Paidos Publications, Barcelona, and is currently co-editing a volume of papers presented at the International Congress on Personal Construct Psychology, University of Hertfordshire, July 2015. Recently he has been researching the work of Charles S. Peirce whose work provides a fascinating meta-framework for looking at and understanding constructivist approaches. Two recent chapters for the new Handbook of Personal Construct Psychology address Relational Construct Psychology and PCP, Society and Culture. He has developed various types of Qualitative Grid, which are user-friendly methods of displaying the construing of members of groups and families, tracing their different positions and charting change over time.

An Update on Evidence-Based Psychosocial Treatments for Eating Disorders in Children and Adolescents

Eating disorders are relatively common and serious disorders in adolescents. However, there are few controlled psychosocial intervention studies with this younger population. This review updates a previous Journal of Clinical Child and Adolescent Psychology review published in 2008. The recommendations in this review were developed after searching the literature including PubMed/Medline and employing the relevant medical subject headings. In addition, the bibliographies of book chapters and treatment guideline articles were reviewed; last, colleagues were asked for suggested additional source materials. Psychosocial treatments examined include family therapy, individual therapy, cognitive behavioral therapy, interpersonal psychotherapy, cognitive training, and dialectical behavior therapy. Using the most recent Journal of Clinical Child and Adolescent Psychology methodological review criteria, family treatment–behavior (FT-B) is the only well-established treatment for adolescents with anorexia nervosa. Family treatment–systemic and insight oriented individual psychotherapy are probably efficacious treatments for adolescents with anorexia nervosa. There are no well-established treatments for adolescents with bulimia nervosa, binge eating disorder, or avoidant restrictive food intake disorder. Possibly efficacious psychosocial treatments for adolescent bulimia nervosa include FT-B and supportive individual therapy. Internet-delivered cognitive behavioral therapy is a possibly efficacious treatment for binge eating disorder. Experimental treatments for adolescent eating disorders include enhanced cognitive behavioral therapy, dialectical behavioral therapy, cognitive training, and interpersonal psychotherapy. FT-B is the only well-established treatment for adolescent eating disorders. Additional research examining treatment for eating disorders in youth is warranted.

Parent and family interventions in pediatric psychology: Clinical applications.

Oklahoma State UniversityParent and family interventions have a long, demonstrated history of utilization in pediatricpsychology settings. The current article will first briefly overview and describe the pre-dominant parent and family intervention approaches used in pediatric psychology, includ-ing traditional family therapy approaches, cognitive–behavioral family therapy, behavioralfamily systems therapy, multisystemic therapy, and problem-solving therapy approaches.Broad strategies for the practical implementation of these interventions are discussed,including working with multiple subsystems, collaboration with interdisciplinary teams,developing shared conceptual models with family and medical team members, and exer-cising both flexibility and clinical judgment with complex cases. Obstacles and barriers tosuccessful implementation of these treatments will next be reviewed, including parent/caregiver characteristics, patient characteristics, economic challenges, medical setting char-acteristics, and communication barriers, as well as recommendations for overcoming thesebarriers. A case study is presented that illustrates a typical family intervention approach.Future directions are reviewed including continued empirical evaluation of family inter-ventions,conductingdismantlingstudies,targetingofresiliencyvariables,andevaluationofelectronically delivered treatments.

Psychological Aspects of Patients and Their Families Suffering from a Rare Disease / Psychologické aspekty pacientov a ich rodín postihnutých zriedkavou chorobou

Severe chronic disease always negatively impacts the psyche of the patient, regardless what organs or organ systems are affected. There are several factors contributing to mental health and serenity, e.g.: quality of health care, social and economic support, personality predisposition of the patient, their partnership, family and wider society relations. Shedding of friendly relations and leisure activities, as well as problems in the partnership are the most serious factors that produce frustration, anger, low self-esteem or even a sense of futility. These emotions, along with pain and fear of disease and fear from the future in many cases eventually lead to depression. Therefore we consider it necessary to pay attention not only to the physical condition of the patient with a rare disease, but also to their psyche; in the broader context of partnership and parenthood. In case of a pediatric patient comfort and serenity of parents has a strongly harmonizing effect on the physical and mental condition of the child. The article deals in detail with the symptoms of distress of the patient and his family, and finally defines the goals of psychological counseling and therapy, including family therapy as a whole.

Parents served by assertive community treatment: Parenting needs, services, and attitudes.

Assertive Community Treatment (ACT) is an evidence-based practice for individuals with severe mental illness. Although at least half of all people with severe mental illness are parents, little is known about their experiences as parents and as recipients of mental health interventions like ACT. The purpose of the current study was to examine the experiences of parent consumers served by ACT. Seventeen parents being served by ACT teams were interviewed about parenting, parenting needs, severe mental illness, satisfaction with ACT services, and suggestions for improved parent-focused treatment services. All parents identified at least one positive aspect of parenting and most parents (77%) also identified negative aspects of parenting. Loss of custody emerged as a significant parenting problem, with most parents (88%) experiencing custody loss at least once. Parents expressed interest in numerous parent-focused services, including family therapy, parenting skills, communication skills training, resources for children, and peer support groups. Most participants with adult children (88%) reported having no unmet parent-related needs and high satisfaction (4.63 of 5) with ACT services, whereas parents with young children (78%) reported having several unmet parenting needs and relatively lower satisfaction (3.78 out of 5) with ACT services. The ACT treatment model may not be adequately serving parents of young, dependent children. Findings suggest the need for more attention and focus on parent consumers, including identification of parental status and improved parent-related treatment services and support.

Étude pilote – un nouvel éclairage attachementiste de l’anorexie mentale : les adolescentes anorexiques ont-elles un attachement insécure ?

ObjectivesAnorexia nervosa is a severe pathology with prevalence among women and the quality of family functioning is involved in the development and the persistence of this disorder and as such is a therapeutic tool of major importance. Among the numerous conceptualisations and models of these familial interactions, attachment theory, originating from John Bowlby's work, provides a useful tool for understanding the interaction of individual and family characteristics, much needed in our clinical work with anorexia nervosa. Attachment theory also integrates solid measures with clinically meaningful constructs. Previous research on attachment and eating disorders has hypothesized direct links between insecure attachment and diagnoses of eating disorders. The aim of the current study is to explore styles of attachment in adolescent girls with anorexia nervosa and in a “healthy” control group with a new self-report attachment questionnaire, the Inventory of Parental Representation. Patients and methodsThis quantitative study is based on the Inventory of Parental Representation completed by six in- and outpatient adolescent girls diagnosed with restrictive anorexia nervosa and six adolescent girls from the general population with no psychiatric disorder. ResultsOur results showed no difference between the clinical and the control groups. All 12 adolescents girls (from both groups) had secure parental representations and attachment styles, although there was a higher proportion of insecure-preoccupied attachment styles in the clinical group for paternal representations, compared to the control group. ConclusionOur results are not in agreement with the current literature and previous findings, which generally tend to find more insecure attachments in eating disorder populations. Firstly most of the studies on attachment in eating disorders are based on adults’ samples but recent research focusing on adolescents obtained findings in line with ours. Indeed, in spite of the fact that some continuity can be observed in attachment strategies from childhood to adulthood, it is possible that the observed pattern of attachment and its relative influence change over the course of development. Although these contradictory findings may not invalidate the link between insecure attachment and psychopathology, they tend to favour more developmental conceptualisations of the role of attachment in anorexia nervosa. Secondly, we recruited patients with no distinction of therapeutic modalities at the time of the study (in- or outpatients). The experience of hospitalisation, which may trigger traumatic separation, the foundation of Bowlby's theory, may contribute to the deactivation and reorganisation of the subject's internal representation models; in contrast, outpatient care may not generate this type of reorganisation. Thirdly, patients from our study all benefited from a multidisciplinary approach including family therapy. The influence of family interventions on attachment strategies must be taken into account since such treatment may contribute to the improvement of the quality of attachment, as suggested by Bowlby. Finally it is possible that the association might exist at the level of eating disorder pathology and of psychiatric symptoms, rather than at a diagnostic level.

Integrating family therapy in adolescent depression: an ethical stance

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

The cost‐effectiveness of family therapy: a summary and progress report

This paper provides a summary of the cost‐effectiveness research for family therapy. Data were available from four different sources in the United States: (1) a health maintenance organization with 180,000 subscribers; (2) the Medicaid system of the State of Kansas; (3) CIGNA Behavioral Health, a division of a health insurance company with nine million subscribers; and (4) a family therapy training clinic. Results suggest that family therapy reduces the number of healthcare visits, especially for high utilizers. The studies suggest that including family therapy as a treatment option does not significantly increase healthcare costs.

Evidence-Based Psychosocial Treatments for Eating Problems and Eating Disorders

Eating disorders represent a significant source of psychological impairment among adolescents. However, most controlled treatment studies have focused on adult populations. This review provides a synthesis of existing data concerning the efficacy of various psychosocial interventions for eating disorders in adolescent samples. Modes of therapy examined in adolescent samples include family therapy, cognitive therapy, behavioral therapy, and cognitive behavioral therapy mostly in patients with anorexia nervosa. At this time, the evidence base is strongest for the Maudsley model of family therapy for anorexia nervosa. Evidence of efficacy for other treatments and other conditions is limited by several methodological factors including the small number of studies, failure to use appropriate control conditions or randomization procedures, and small sample sizes (i.e., fewer than 10 participants per treatment arm). Potential moderators and mediators of treatment effect are reviewed. Finally, results from adolescent studies are contrasted with those from adult studies of eating disorders treatment. Many studies of adult populations comprise late adolescent/young adult participants, suggesting that findings regarding the efficacy of cognitive behavioral therapy for bulimia nervosa in adults likely extend to older adolescent populations.