Systemic Psychotherapy Research Articles

The uses of emotion maps in research and clinical practice with families and couples: methodological innovation and critical inquiry.

We explore how “emotion maps” can be productively used in clinical assessment and clinical practice with families and couples. This graphic participatory method was developed in sociological studies to examine everyday family relationships. Emotion maps enable us to effectively “see” the dynamic experience and emotional repertoires of family life. Through the use of a case example, in this article we illustrate how emotion maps can add to the systemic clinicians’ repertoire of visual methods. For clinicians working with families, couples, and young people, the importance of gaining insight into how lives are lived, at home, cannot be understated. Producing emotion maps can encourage critical personal reflection and expedite change in family practice. Hot spots in the household become visualized, facilitating dialogue on prevailing issues and how these events may be perceived differently by different family members. As emotion maps are not reliant on literacy or language skills they can be equally completed by parents and children alike, enabling children's perspective to be heard. Emotion maps can be used as assessment tools, to demonstrate the process of change within families. Furthermore, emotion maps can be extended to use through technology and hence are well suited particularly to working with young people. We end the article with a wider discussion of the place of emotions and emotion maps within systemic psychotherapy.

A survey of the provision of family therapy in medium secure units in Wales and England

A cross-sectional survey design was utilised to capture a snapshot of the provision of family therapy in medium secure units (MSUs) across Wales and England during 2013. Semi-structured interviews were administered via telephone interview with 39 MSUs. Information pertaining to the main research question was also gathered from a further 10 via email follow-up. Over a third of responding MSUs in Wales and England were offering family therapy, with team members being appropriately qualified and receiving regular supervision. Systemic psychotherapy was the most prevalent approach to working with families and it is suggested here that systemic psychotherapy fits well with the complexity and uniqueness of working with families in secure contexts.

Reflections on the challenges of understanding racial, cultural and sexual differences in couple relationship research.

In the field of systemic psychotherapy there has been much recent interest in the areas of culture and reflexivity, and in working with couples. In this article we reflect on the process of conducting research in these areas. Drawing on findings from a large, national, empirical mixed-methods study on long-term relationships, we use two examples from the data to illustrate the complexity of researching across racial, cultural and sexual differences, in terms of research design and sampling, fieldwork and research practice, and making sense of multidimensional data. We point to findings that suggest that notions of coupledom are culturally constructed and thus challenge straightforward ideas of the procreative, sexually active couple dyad, separate from intergenerational extended families. The clinical significance of the findings for both lesbian, gay, bisexual or queer and culturally diverse couples and families are discussed.Practitioner pointsCultural or racial matching is not a sufficient condition for engagement and empathy with couples and families.Critical reflexivity about similarity and difference is essential in cross-cultural systemic practice.‘The couple’ and its distance from the extended family may be defined differently in different cultures.One research tool used in this project, the emotion map, appears to have utility in clinical practice with couples and families.

The Applicability of Two Strengths-based Systemic Psychotherapy Models for Young People Following Type 1 Trauma

This paper will consider the inter-relationship of a number of overlapping disciplinary theoretical concepts relevant to a strengths-based orientation, including well-being, salutogenesis, sense of coherence, quality of life and resilience. Psychological trauma will be referenced and the current evidence base for interventions with children and young people outlined and critiqued. The relational impact of trauma on family relationships is emphasised, providing a rationale for systemic psychotherapeutic interventions as part of a holistic approach to managing the effects of trauma. The congruence between second-order systemic psychotherapy models and a strengths-based philosophy is noted, with particular reference to solution-focused brief therapy and narrative therapy, and illustrated; via a description of the process of helping someone move from a victim position to a survivor identity using solution-focused brief therapy, and through a case example applying a narrative therapy approach to a teenage boy who suffered a serious assault. The benefits of a strength-based approach to psychological trauma for the clients and therapists will be summarised and a number of potential pitfalls articulated.

EPA-0333 – Psychotherapy in people with intellectual disabilities

The use of psychotherapeutic strategies in people with intellectual disabilities (ID) is at different stages in various countries in Europe. The UK and Ireland use special modified psychotherapeutic programmes for people with ID but there appears not to be many resources in psychotherapy in other European countries. The presentation considers the different psychotherapeutic approaches published in the scientific literature within the last ten years. To ascertain the use of psychotherapy in people with intellectual disabilities in Europe. ‘Psychotherapy‘, ‘intellectual‘, ‘developemental‘, and ‘disabilities’ were chosen as keywords in searching the databases. Abstracts of publications were grouped in to psychotherapy models, Cognitive Behavioural Therapy, Systemic Psychotherapy, Analytic Psychotherapy. Sub-groups included other models, for example group psychotherapy. The formats of publications were defined as case report, structured assessment, analysis of therapeutic methods The database research revealed nearly 300 publications on psychotherapy in people with ID over a ten-year period. It supports the assertion of the use of psychotherapy in ID. Most publications reported on work undertaken in the United Kingdom. The presentation gives more detailed information about the relationship between cognitive behavioural and analytic-oriented strategies, intervention type and study characteristics. There is currently a good evidence base on the use of psychotherapeutic methods in working with people with ID. Much of it is in the English language literature. There is potential for the development of models to be applied in ID. The use of psychotherapeutic approaches in ID needs to be encouraged across healthcare systems in Europe.

EPA-0581 - Long-term integrative psychotherapy of anxiety disorders in mitral valve prolapse patients: the factors of mental health improvement

Introduction Mitral valve prolapse (MVP) is a common cardiac pathology. There are some cases of a reduction in the intensity of clinical symptoms after the courses of psychotherapy and anxiolitic treatment of MVP patients (Stavrakaki, et al., 1991; Scordo, 2007). Objectives To identify personality characteristics, emotional features and stress factors in MVP patients suffering anxiety disorders (AD). Aims To investigate the factors of mental health improvement under the long-term systemic integrative psychotherapy in MVP patients with AD. Methods During 15 years 14 MVP patients with AD attended integrative psychotherapy on request. Psychological and clinical examinations of the patients were made before and after psychotherapy courses. Psychological testing embraced the assessment of’quality of life’ indicators by VAS, DISS and the Ryff Scales (PWB) as well as anxiety level (Spilberger Scales), and the level of frustration tolerance (Rosenzweig test). The psychotherapy program consisted of the elements of CBT, Gestalt therapy, Interpersonal psychotherapy, and Psychodynamic Psychotherapy. Results 72,2% patients demonstrated valid improvements of QOL self-rating, reduction of anxiety level, and increasing of frustration tolerance after psychotherapy. Moreover, medical diagnostics showed a significant reduction in the depth of MVP. Positive dynamics was associated with development of personality reflection, his/her emotional experience recognition, with improved skills of self regulation, and growing awareness of actual needs, individual purposes and resources of personality. Conclusions The importance of personality reflection and working on traumatic experiences and personality problems to reveale inner resources; as well as extension of one's repertory of coping processes were specified as facilitating factors.

EPA-1021 - Peculiarities of emotional damages in patients with anxiety disorders

The aim of the study the development of a comprehensive system ofpsychotherapy and psychocorrection of anxiety disorders of neurotic case, based on the study of their clinical structure and peculiarities of emotional damages. Methodologies Clinical and psychological investigation, included the scales of anxiety and uneasiness CH.D. Spielberger, Eysenck Personality Questionnaire (EPQ), The Hamilton Rating Scale for Depression (HRSD), The studyof accentuation of personality by K.Leonhard. Scope and contributing research 100 patients with diagnostic categories: F41.0 - Panic disorder(episodic paroxysmal anxiety, F41.1-Generalized anxiety disorder, F41.2-mixedanxiety-depressive disorder who are on the examination and treatment at the psychiatric unit. A control group included 40 patients. We performed the explorationof the peculiarities of clinical anxietyand patterns of therapeutic effect, based on the influence of short-term groupand individual psychotherapy in the treatment of anxiety disorders, andevaluation the effectiveness of its reconition. The development of the methodology of applying a short-term group and individual psychotherapy in the treatmentof anxiety disorders based on combination relaxation, hypnosis, cognitive-behavioral teqniques in combination on with short-term group therapy. In fact, this is a new realmodel psychotherapy based on integrative principles. The higt efficacy was shown in 82% patients, compared with 54% efficacy in control group patients. We will offer a new comprehensive methodology in the treatment of anxiety disorders of neuroticcase that will improve the therapeutic efficacy of the treatment process, reduce the time of treatment, reduce the period of drug therapy

The Treatment of Depressive Disorders in Children and Adolescents

Depressive disorders are among the more common mental illnesses around the world. About 3% of prepubertal children and 6% of postpubertal children and adolescents are affected. Many physicians are unsure about which treatment approaches are effective and how the treatment should be planned. A systematic literature search was carried out in electronic databases and study registries and as a manual search. More than 450 studies (mostly randomized controlled trials [RCTs]) were identified and summarized in five evidence tables. The ensuing recommendations were agreed upon in a consensus conference in which 23 organizations were represented. The recommended treatment of first choice for children from age 8 onward and for adolescents is either cognitive behavioral therapy (CBT) (Cohen's d [effect strength]: 0.5-2) or interpersonal psychotherapy (Cohen's d: 0.5-0.6). Fluoxetine is recommended for drug treatment (Cohen's d: 0.3-5.6), either alone or in combination with CBT. The analysis revealed a lower level of evidence for psychodynamic or systemic psychotherapy or for drug treatment with escitalopram, citalopram, or sertraline. For mild or moderate depression, psychotherapy is recommended; for severe depression, combination therapy. Particularly for children, there is a lack of adequately informative comparative studies on these treatment approaches as well as on other, complementary interventions (e.g., art therapy, sleep deprivation, youth welfare services). There is adequate evidence to support some recommendations for the treatment of depressive disorders in adolescents, but evidence for children is lacking. There is a pressing need for intervention research in this area for both children and adolescents.

A philosophy of practice for systemic psychotherapy: the case for critical realism

An argument is made for Bhaskar's critical realism as a more coherent, accountable and enabling philosophy of practice for systemic psychotherapy than the kinds of strong constructionism and pragmatism that are currently powerful in our field. Constructionism is positioned, not as an opponent to realism in the usual way, but – in a moderate version – as a necessary partner to give realism its critical edge. The dimensions of critical realism are sketched and its potential for the coherent support of practice is illustrated with an analysis of a moment of therapeutic change.Practitioner points Critical realism supports the understanding of multiply interacting causal tendencies, from genetics to discourse, providing a new platform for eclecticism and integration and a renewed, though cautious, relationship with science. The growing split between structuralism and poststructuralism is closed by critical realism, giving the potential for systemic family therapy to become a unified field. The covert use of realism by clinicians is made accountable by critical realism.

The path towards a professional identity: An IPA study of Greek family therapy trainees

Objective: Contemporary psychotherapy research has focused mainly on practitioners' training and education. The impact of training on professional development and the application of therapeutic skills have been the primary foci of the empirical literature. The aim of this paper is to present the experiences of seven family therapy trainees regarding their personal paths toward the development of professional identity as they underwent training in systemic psychotherapy. Method: In‐depth interviews were conducted and analysed using Interpretative Phenomenological Analysis. Results & Conclusions: Seven themes were identified: The Quest, Developing by Relating, Learnings, Personification of Training, Use of Self, Self‐Care and Empowerment, and Reflecting on the Role of the Therapist. The findings are discussed with regard to the development of the ‘therapist as a person’, gaining acknowledgement and autonomy, and the development of a community of therapeutic practice.

Multidimensional psychosexual therapy: a model of integration between sexology and systemic therapy

This paper summarises the author's theoretical and practical integration of sexology and systemic psychotherapy illustrated with clinical examples of multidimensional psychosexual therapy practice. The Model is applicable to treating a wide variety of presenting sexual concerns.

La cothérapie en psychologie clinique interculturelle

Numerous clinicians practicing systemic psychotherapy have recognized the relevance of co-therapy, an intervention model involving at least two clinicians. Intercultural psychology and ethnopsychiatry have been inspired by the principles of co-therapy and have adapted it to the intercultural context. Our objective is to illustrate how co-therapy works in intercultural psychology, as it has been developed by the Specialized Psychological Services for Immigrants and for Refugees (SAPSIR). This intervention model facilitates the working through processes of mourning and of identity, important issues with migrant individuals. Finally, this practice cannot be reduced to the mere application of techniques including some cultural elements; it implies a special way of being in relationship with others, with oneself and with one's knowledge.

Analytic versus systemic group therapy for women with a history of child sexual abuse: 1‐Year follow‐up of a randomized controlled trial

This randomized prospective study examines durability of improvement in general symptomatology, psychosocial functioning and interpersonal problems, and compares the long-term efficacy of analytic and systemic group psychotherapy in women 1 year after completion of treatment for childhood sexual abuse. Women (n = 106) randomly assigned to analytic or systemic psychotherapy completed the Symptom Checklist-90-R, Global Assessment of Functioning, Global Life Quality, Registration Chart Questionnaire, and Flashback Registration at pre-treatment, post-treatment, and at a 1-year follow-up. Post-treatment gains were significant for both treatment modalities on all measures, but significantly larger after systemic therapy. Significant treatment response was maintained 1-year post-treatment, but different trajectories were observed: 1 year after treatment completion, improvements for analytic therapy were maintained, whereas they decreased after systemic therapy, resulting in no statistically significant difference in gains between the groups at the 1-year follow-up. Despite maintaining significant gains, more than half of the patients remained above cut-off for caseness concerning general symptomatology at post-treatment and at 1-year follow-up. The findings stress the importance of long-term follow-up data in effect studies. Different trajectories were associated with the two treatments, but improvement in the two treatment groups did not differ significantly at the 1-year follow-up. Implications of the difference in trajectories for treatment planning are discussed. Both analytic and systemic group therapy proved efficient in improving general symptomatology, psychosocial functioning, and interpersonal problems in women with a history of CSA and gains were maintained at a 1-year follow-up. Despite maintaining statistically significant gains at the 1-year follow-up, 54% of the patients remained above the cut-off for caseness with respect to general symptomatology, which may indicate a need for further treatment. Different pre-post follow-up treatment trajectories were observed between the two treatment modalities. Thus, while systemic group therapy showed a significantly better outcome immediately after termination, gains in the systemic treatment group decreased during follow-up, while gains were maintained during follow-up in analytic group therapy.

Attracting young academics into the field of psychiatry and psychotherapy in Switzerland – The Zurich ‘study focus on psychiatry’ and training concept for medical psychotherapy

For several years the demand regarding psychiatrists in Switzerland can only be satisfied by recruiting colleagues from other countries. Given the global increase of mental disorders, initiatives encouraging young academics to choose psychiatry as their speciality, and enhancing the attractiveness of our field, are urgently needed. Two projects for the promotion of young academics are presented in this paper, one working with medical students, the other with residents in psychiatry. The Zurich ‘Study Focus on Psychiatry’ provides medical students with knowledge and key competencies in psychiatry at an early stage of their undergraduate training. This way, students are offered an opportunity to have a thorough look into psychiatry as a clinical specialism and as a science. The three-year psychotherapy training curriculum in medical psychotherapy provides residents in psychiatry and psychotherapy with specific training in either cognitive behavioural, or psychodynamic, or systemic psychotherapy. Additionally, and independent of the psychotherapeutic orientation they have chosen, all trainees attend joint sessions focusing on generic elements of psychotherapy and facilitating a hands-on transfer of psychotherapeutic principles into their clinical routine. These two projects aim at enhancing the attractiveness of psychiatry and psychotherapy as a speciality, and thus contributing to the promotion of young academics.

Clinical effects of escitalopram treatment combined with psychological interventions during peri-parturition period for patients with postpartum depression

Objective To explore the clinical effects of escitalopram combined with psychological interventions during peri-parturition period for patients with postpartum depression. Methods From July to December in 2012, totally 493 pregnant women were performed psychological interventions during peri-parturition period, and 34 cases of them who suffered from postpartum depression were treated with escitalopram 10mg daily combined with systemic psychotherapy as the study group. From January to June in 2012, totally 367 pregnant women were not performed psychological interventions during peri-parturition period, and 32 cases who suffered from postpartum depression were treated with escitalopram 10 mg daily and only with support psychotherapy as the control group. Both groups were observed for 8 weeks. The Hamilton rating scale (HAMD) and Clinical Global Impression-severity of illness (CGI-SI) were tested before treatment and after 1, 2, 4 and 8 weeks of treatment to evaluate the efficacy.The data were compared. Results The incidence of postpartum depression was 7.7% in the study group which was significantly lower than that in the control (11.7%, χ2=3.96, P 0.05). Conclusion Psychological interventions during peri-parturition period and escitalopram treatment combined with systemic psychotherapy in depression stage had better effects on preventing and curing postpartum depression. Key words: Escitalopram; Peri-parturition period; Psychotherapy; Postpartum depression

CAM in Psychiatry.

In western countries, the 19th century marks a turning point for the beginning of psychiatry as an academic discipline. Since this happened and psychiatry had left the asylums at the boundaries not only of cities but medicine itself, we can find quite a row of examples concerning integration [1]. Psychiatry has integrated many treatments into the therapeutic spectrum, for example, tricyclic antidepressants, SSRI, relaxation techniques like progressive muscle-relaxation or hypnosis, cognitive-behavioural, psychoanalytic, or systemic psychotherapy, even acupuncture according to the protocol of the National Acupuncture Detoxification Association (NADA) [2, 3] or lately mindfulness-based cognitive therapy [4]. However, three aspects seem suitable to understand the openness of psychiatry for new methods: (a) the fact that since decades, professional multidisciplinarity in psychiatry is a crucial basis for the inand outpatient treatment (e.g., psycho-, ergo-, music-, physiotherapists, nutritionists, and social workers), (b) psychiatrists today need to have a double qualification in psychiatry and psychotherapy to be able to work according to (c), Engel’s biopsychosocial model, which had been adopted as a solid basis for the previously mentioned.

924 – Synergetic integrative model of group psychotherapy for schizophrenic patient relatives

Introduction The authors propose an integrative approach in group work psychotherapy for schizophrenic patient’s relatives. This approach integrates three components into session: psycho education (knowledge for systemic family psychotherapy), cognitive behavior (family solving problem skills) and psychotherapy (reflection and coping strategies). These components are integrative for communication process, which provides their synergetic interaction within the theme educate limits. Objectives Study the effectiveness of a synergetic approach in enhancing the impact of rehabilitation. Aims Identifying markers of efficacy of the approach through a comparative analysis of the two groups of mothers of patients, one of whom used a synergistic approach, in the other using traditional programs. Methods SCL-90-R (Derogatis); URICA (McConnaughy); MSPSS(Zimet). Objective conclusion is provided by using Mann-Whitney U-test. Results Synergetic integrative approach to group therapy significantly affects the reduction of somatization (p = 0,05), depression (p = 0,01), hostility (p = 0,05) and Global Severity Index (p = 0,05). In participants of the experimental group was significantly higher overall perception of social support (p = 0,01), measures of social support from family (p = 0,05), friends (p = 0,01) and significant others (p = 0,05). Diagnostic stage of psychotherapeutic process showed that participants of the control group mostly are on initial stages of therapy, while the experimental group members are at a mature stage. Conclusions Synergetic integrative approach showed high efficiency to work with the families of schizophrenic patients by reducing the level of psychiatric symptoms, enhance feelings of social support and accelerate the psychotherapeutic process.

Family myth, the symbolic realm and the ancestors

This paper takes the shape of a diptych. The first part explores the ancestors as embodied ghosts, internal objects or as mediated through ancestral heritage, as these aspects intertwine in a Möbius strip. The second part looks at ancestral heritage and the different ways in which 'family myth' appears in a Jungian context and in Systemic Psychotherapy (family therapy). Both share an interface through the current paradigm shifts towards mutual reflexivity in patient and therapist and a focus on the interpersonal space. The ancestors give substance to the eternal riddle: 'from whence do we come, who are we and where do we go', which connects past, present and future. Our ancestors are part of our minds, perhaps in the way Damasio (2010) postulates that ancestral experiences mediated through culture shape our brains. The leitmotiv of individuation through mimesis (sameness) and alterity (difference) runs through both parts.

Constructions and enactments of whiteness: a discursive analysis

Systemic therapists have argued that it is important to re‐examine issues about white identities if they are to develop cultural competence and cultural sensitivity. Despite this, few studies have explored whiteness in systemic psychotherapy. This small‐scale qualitative study therefore explores how a group of white systemic psychotherapists (trainers and trainees) construct whiteness, how these constructions or discourses facilitate or constrain talk about whiteness and how this influences what therapists do in therapy. The research method used was focus group discussions and an action research approach. The data were analysed using Foucauldian discourse analysis and three main discourses were made apparent: ‘whiteness as an invisible norm’, ‘political correctness’ and ‘systemic therapy discourses’. These discourses are described and the implications, discussed.

Patients’ Perceptions of Risky Developments During Psychotherapy

Research on risks and unwanted effects is largely missing in psychotherapy. Using exploratory factor analysis six dimensions of personal therapy situation were identified in a preliminary study, three of them were associated with risky developments during the psychotherapeutic process: (1) (poor) quality of therapeutic relationship, (2) burden caused by psychotherapy, and (3) dependency/isolation. Based on the finding of this study an online survey was performed to examine these three dimensions. Aside from these three factors another variable was associated with risky therapy developments: the online questionnaire also asked for premature terminations of psychotherapy as a consequence of risky conditions for the therapeutic development. Risky conditions were found to be associated with the following variables: (1) the combination of female patient–male therapist, (2) the therapeutic orientation (particularly with the psychodynamic approaches) and (3) the duration of therapy. Fewer humanistic and systemic psychotherapies were found among the high risk-prone group of patients who were at risk in at least three of the four variables which were associated with risky developments. Differences in the findings of the study regarding the four therapeutic orientations stress the importance of an extensive differential indication and a cooperative partnership between patient and therapist, in order to facilitate a positive patient participation towards the choice of therapy method and subsequent successful participation throughout the course of treatment. Further studies should also focus on female patient and male therapist psychotherapies.