Systemic Family Therapy Research Articles

Systemic family therapy for severe functional disorders in youths: a qualitative study in a psychiatric setting

This study aimed to explore participant experiences of systemic family therapy for youths with functional disorders. After completing family therapy, eight youths and thirteen parents participated in qualitative interviews. The analysis was based on interpretative phenomenological analysis and identified two main themes. The first theme was: ‘Challenges of creating meaning and understanding of child symptoms in family therapy’, with symptom understanding and explanation found to be important, though sometimes challenging, themes in therapy. The second theme was: ‘Clinical encounters in family therapy promote dialogue’, which included the finding that the family therapy setting with joint sessions for family members facilitated in‐family communication.Practitioner points Addressing family dynamics during therapy can be experienced as an invasion of the family domain Symptom explanations should avoid any suggestion of blame and remove feelings of guilt, be relatable and meaningful and point to solutions for the family Systemic family therapy can support empowering processes for families of youths with functional disorders

Where is the Family in Young Adult Substance Use Treatment? The Case for Systemic Family Therapy for Young Adults with Substance Use Disorders.

Despite the prevalence of SUDs, many individuals remain untreated (Grant et al., JAMA Psychiatry, 73(1), 39-45, 2016). Substance use disorders (SUDs) in young adults present unique challenges and stressors to parents of these individuals (D’Aniello et al., American Journal of Family Therapy, 2020; Kaur et al., International Journal of Community Medicine and Public Health, 5(6), 2380-2383, 2018; Shumway et al., Alcoholism Treatment Quarterly, 37(1), 75-98, 2019). Parents and caregivers often facilitate their children’s care and provide pragmatic and emotional support to their children; this high level of care is challenging to maintain, as with any chronic, relapsing condition. In the case of SUDs, the challenges caregivers face may be exacerbated by the stigma and the blame associated with parents in the development and maintenance of children’s SUDs, and the strains that come with navigating barriers related to accessing treatment in the USA. Estimates suggest that healthcare spending for substance use treatment is relatively low and few utilize therapeutic family treatment. This disconnect between widespread SUD prevalence, and service underutilization, indicates that families who need treatment are not accessing it. The present paper synthesizes the extant literature on the role of family members in SUD treatment, as families are a primary context of care for their children’s treatment across many chronic, relapsing conditions. Finally, we identify the utility of family therapy in addressing family member’s unique needs related to their loved one with a SUD, in the family and in a treatment context.

“Your Exile is Showing”: Integrating Sandtray with Internal Family Systems Therapy

Internal family systems (IFS) therapy is an experiential model of therapy and views individuals as having numerous “parts” inside of them. These parts maintain a specific role in a client’s life and fall under one of the three categories – managers, exiles, and firefighters. Due to the experiential aspect of IFS and the concept of blending, visualizing the parts inside of a client can become challenging at best and impossible, at worst. This article provides a framework for integrating sandtray therapy with IFS to help clients name, visualize, and see the progress of their parts.

Exploring Differences in the Role of Hospitalization on Weight Gain Based on Treatment Type From Randomized Clinical Trials for Adolescent Anorexia Nervosa.

Background: This study explores the impact of weight gain during medical stabilization hospitalization on weight outcomes between three outpatient treatments for adolescent anorexia nervosa (AN): Adolescent Focused Therapy (AFT), Systemic Family Therapy (SyFT), and Family Based Treatment (FBT).Methods: A secondary analysis of weight gain data (N = 215) of adolescents (12–18 years) meeting DSM-IV criteria for AN (exclusive of amenorrhea criteria) who participated in two randomized clinical trials (RCTs) was conducted. Main outcomes examined were changes in weight restoration (≥95% expected body weight or EBW) and differences in weight change attributable to hospital weight gain.Results: Weight gain resulting from hospitalizations did not substantially change weight recovery rates. Hospital weight gain contributed most to overall treatment weight gain in AFT compared to FBT and SyFT.Conclusion: Brief medical stabilization weight gain does not contribute substantially to weight recovery in adolescents with AN who participated in RCTs.

Fidelity and influencing factors in the Systemic Practice Model of children's social care in Finland

• An adaptation of the RSW model was implemented nationwide in Finland. • There was high variability in fidelity both across sites and in the teams within them. • Despite the implementation challenges, social workers widely accepted the model. • The vague model description impeded the uptake of systemic practice in social work. • The model could be adopted in new settings with adequate implementation support. Given that multiple countries have recently adopted social work practice models in children’s services, it is striking that only a few studies have systematically analysed both the level of fidelity and potential implementation barriers and facilitators. The aim of this study is to provide an in-depth analysis of how and why the Reclaiming Social Work (RSW) model works in different settings. The study context was the implementation in Finland of an adaptation of the model, the Systemic Practice Model (SPM). This mixed-methods study evaluates 1) fidelity to the SPM and 2) the possible influencing factors. The results reveal high variability in the extent of fidelity in 23 implementation sites, and even among individual teams within the same site. A lack of clarity concerning systemic social work practice, insufficient training, and inadequate resources and leadership hindered the implementation, whereas coaching and positive experiences of the SPM were facilitating factors. In particular, the involvement of a clinician qualified in systemic family therapy was crucial in embedding the new approach. The relationship between the level of fidelity and the influencing factors worked both ways (e.g., low coverage was associated with a decrease in participant responsiveness, and vice versa). Given the complexity of children’s social care as an implementation environment, careful preparation and ongoing support are crucial in the implementation of practice models.

Θεραπευτικές παρεμβάσεις και σημαντικές ενδοσυνεδριακές στιγμές στη συστημική οικογενειακή ψυχοθεραπεία

The purpose of this study was to investigate the psychotherapeutic process in family integrative systemic therapy that lead to therapeutic change. More specifically, the study investigated the relation between therapist interventions and in-session good moments at different phases of therapy. The sample consisted of five families with good therapeutic outcome at three different stages of therapy - beginning, middle, and ending. Results indicated the appearance of specific good moments and therapist’s interventions at different stages of therapy, as well as significant correlations between therapist interventions and client good moments. This study sheds light on the complex processes of systemic family therapy and the variables that contribute to good therapy outcome.

Developing Reflexivity through Group Processes in Psychotherapy Training: An Interpretative Phenomenological Analysis of Systemic Family Therapy Trainees' Experience.

Constructionist approaches in the field of systemic family therapy prioritize reflexivity to promote personal development within training, often leaning on group processes. Drawing from a qualitative study we conducted to address the lack of related research, we present how systemic family therapy trainees experience reflexivity development through group processes. Ten systemic family therapy trainees participated in semi-structured interviews, transcribed and analyzed with interpretative phenomenological analysis. Analysis presented here reports three superordinate themes: Developing reflexivity through challenges and rewards, A conditional reflexive space within the training group, and Encountering the dynamics of identity via reflexive group processes. Our findings suggest that trainees experience reflexivity development as a complex relational process of personal development, highlighting the training group's critical role, nonetheless depending on certain preconditions. The importance of further exploring group processes' potential for reflexivity development in psychotherapy training is underscored.

An Integrative Approach to Relational Psychoanalysis

ABSTRACT Recent research in cognitive neuroscience, as well as in therapeutic approaches such as Internal Family Systems Therapy (IFS) and Sensorimotor Psychotherapy, offer ways of empowering psychoanalytic therapy within the framework of contemporary psychoanalysis’s basic principles. A clinical vignette illustrating an effective application of psychotherapy integration is presented. In order to benefit from importing these outside insights and methods, some analysts will need to overcome singlemindedness and relax elitist notions of the superiority of their staunch approach. As the hegemony of psychoanalysis continues to decline, an integrative strategy of this sort can vitalize psychoanalysis and ensure its legacy while also helping nonanalytic therapists realize the ways their approaches intersect with and can benefit from ours.

The Systemic Assessment Clinic, a Novel Method for Assessing Patients in General\xa0Adult Psychiatry: Presentation and Preliminary Service Evaluation

The traditional model of psychiatric assessment and diagnosis can be criticised as reductive. We developed an innovative model for psychiatric assessment of adult patients referred to our adult mental health team, the Systemic Assessment Clinic, incorporating the principles and techniques of systemic family therapy and dialogical practice into standard psychiatric assessment. We conducted a service evaluation, comparing prospective use of mental health services for patients assessed either in the Systemic Assessment Clinic or in standard assessment. Patients assessed in the Systemic Assessment Clinic had more favourable outcomes than those in standard assessment: they were significantly less likely to need multiple follow-up treatment appointments with a psychiatrist and to be re-referred to mental health services once discharged, indicating reduced healthcare costs. Satisfaction rates for participants attending the systemic assessment clinic were high. Our service evaluation gives preliminary evidence that the Systemic Assessment Clinic could be a potential new model for psychiatric assessment; further evaluation is warranted in a randomised controlled trial.

Sense of coherence in systemic family therapy trainees in times of change

This study aimed at qualitatively exploring the development of a sense of coherence (SOC) among systemic family therapist trainees (FTT) over a 3-year period. It was conducted in a private family therapy training institute in central Germany. The sample consisted of 66 trainees. The components of SOC and their general health played an important role in the development of FTTs throughout the three training years. Findings show that the SOC component of meaningfulness (motivation) was most frequently mentioned and most important to participants’ personal and professional development, followed by comprehensibility (understanding of self, others and the context) and finally by manageability (coping with challenges based on personal, social and professional resources). The three SOC components fostered a positive self-care approach in FTTs and improved health and well-being over the 3 years. Visions of FTT at the end of the training show that they aim at personal and professional growth and development in the Fourth Industrial Revolution (4IR).

Freedom and struggling openly in psychotherapy: A qualitative inquiry with LGBQ young adults from religious families.

Lesbian, gay, bisexual, and queer (LGBQ) young people from religious families are at increased risk of family rejection, poor mental health outcomes, and are overrepresented in mental health services. This article describes a two-part qualitative study aimed at exploring the experiences of LGBQ young adults from religious families in psychotherapy, identifying positive and negative psychotherapy experiences, and understanding the influence of family and religion on the psychotherapy experience. Data were collected through a web-based survey (n=77) and interviews (n=7) with LGBQ young adults (ages 18-25) from religious families. The study followed an interpretative phenomenological approach. Integrated results found often invisible, relational therapy processes, and religious discourses as significant to LGBQ young people who seek psychotherapy. Implications for future research, effective systemic family therapy practices with LGBQ young people from religious families, and a critique on ethical and legal limits of confidentiality with policy implications are outlined.

The Influence of School-Based Family Counseling on Elementary Students and Their Families

A family counseling intervention grounded in systemic family therapy was conducted in a Title I school-based setting with ( N = 48) kindergarten through sixth-grade student-clients and their primary caregivers. Families’ perception of family communication and satisfaction on the Family Adaptability and Cohesion Evaluation Scale-IV was investigated to determine changes in the percentile score at three benchmarks. A repeated measure analysis of variance indicated a statistically significant difference over time in caregivers’ perception of family communication and satisfaction after 5 and 10 weeks. There was no difference in relationship to gender. School-based family counseling programs can contribute to improved family communication and satisfaction. School-based counselors can partner with institutions of higher education to provide free and accessible counseling for students and families in the greatest need.

Long-Term Efficacy of the Workshop Vs. Online SUCCEAT (Supporting Carers of Children and Adolescents with Eating Disorders) Intervention for Parents: A Quasi-Randomised Feasibility Trial.

Interventions for main carers of adult patients with anorexia nervosa (AN) can reduce the caregiving burden and increase caregiver skills. However, the effectiveness and feasibility for carers of adolescent patients, the optimal form of the intervention and long-term outcomes are largely unknown. We evaluated the efficacy and feasibility of the “Supporting Carers of Children and Adolescents with Eating Disorders in Austria” (SUCCEAT) workshop vs. online intervention. Main caregivers (parents) of adolescent patients with AN were randomly allocated to a workshop (n = 50) or online version (n = 50). Participants were compared to a non-randomised comparison group (n = 49) receiving multi-family or systemic family therapy. Primary (General Health Questionnaire) and secondary outcomes were obtained at baseline, three-month and 12-month follow-up. Adherence was high for workshop and online participants (6.2 and 6.7 sessions completed out of 8). Intention-to-treat analyses revealed significant pre–post reductions in the primary outcome for the workshop (d = 0.87 (95%conficence interval (CI): 0.48; 1.26)) and online (d = 0.65 (95%CI: 0.31; 0.98)) intervention that were sustained at the 12-month follow-up. There was no significant group difference (p = 0.473). Parental psychopathology and burden decreased and caregiver skills increased in all groups; the improvement of caregiver skills was significantly higher in SUCCEAT participants than in the comparison group. Online interventions for parents of adolescents with AN were equally effective as workshops. The improvements remained stable over time.

Publication Trends in Psychotherapy: Bibliometric Analysis of the Past 5 Decades.

Bibliometric analyses are commonly used to document publication trends over time; however, this methodology has not been used to investigate possible trends concerning publishing about psychotherapy brands. In this study, the authors sought to identify the publication trends of peer-reviewed articles about 30 psychotherapy brands. Analyses were focused on the past 50 years and on each decade from 1970 to 2019. All searches were performed between October 2018 and January 2019 on the EbscoHost platform. Two databases were selected for the searches: PsycINFO and PubMed. In the 28,594 articles reviewed, most published articles concerned cognitive-behavioral therapy (CBT), and five brands accounted for almost 78% of all publications: CBT, psychoanalysis, family systems therapy, behavioral therapy, and cognitive therapy. Three trends were identified across decades: five therapies consistently yielded the largest number of publications, the number of publications focused on therapies with less research support declined from the 1970s to the 1990s, and publications about therapies with more of a research basis increased in the 1990s through the 2010s. Publications on meditation and mindfulness presented the most salient growth area for all psychotherapies across the 5 decades. A few psychotherapy brands have dominated the publishing realm during the past 50 years and across each decade. Possible explanations for these publication trends were considered, including the emergence of the evidence-based therapy movement and various sociohistorical changes. Potential psychotherapy publications trends in the future are discussed.

Recommendations for the support of suffering, severely ill, dying or grieving persons in the corona pandemic from apalliative care perspective : Recommendations of the German Society for Palliative Medicine (DGP), the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI), the Federal Association for Grief Counseling (BVT), the Working Group for Psycho-oncology in the German Cancer Society, the German Association

Die mit der Corona-Pandemie einhergehenden Einschränkungen und Verbote sorgen für psychische, soziale und spirituelle Belastungen bei Patient*innen mit COVID-19, ihren Zugehörigen und den behandelnden Mitarbeitenden im Gesundheitswesen. Patient*innen mit COVID-19 dürfen nicht von ihren Zugehörigen besucht werden, in vielen Krankenhäusern und Pflegeeinrichtungen gelten generelle Besuchsverbote. Viele Unterstützungsangebote sind verringert oder ganz eingestellt worden. Bei anderen Patient*innen mit sehr kritischen und/oder lebenslimitierenden Erkrankungen werden notwendige Behandlungsmaßnahmen aufgeschoben, weil die Ressourcen im Krankenhaus für an COVID-19 Erkrankte freigehalten werden. Diese Menschen bedürfen jedoch des Gefühls der sozialen Verbundenheit mit ihren Zugehörigen. Für Palliativpatienten sollten Ausnahmen von Besuchsverboten ermöglicht werden. Besuche bei Sterbenden sind mit entsprechenden Schutzmaßnahmen auch auf Isolier- oder Intensivstationen möglich. Für isolierte Patient*innen sollten alternative Möglichkeiten überprüft werden, zum Beispiel via Videotelefonie oder über soziale Medien. Nach dem Versterben sollte den Angehörigen unter ausreichenden Schutzmaßnahmen ein Abschiednehmen ermöglicht oder alternative reale oder virtuelle Wege zum Erinnern und Gedenken angeboten werden. Die Mitarbeitenden in den Behandlungsteams sollten kontinuierlich in der Bewältigung der besonderen Belastungen unterstützt werden. Dazu ist neben klaren Kommunikations- und Entscheidungsstrukturen, Kommunikationsschulungen und psychosozialer Unterstützung vor allem die Bereitstellung der bestmöglichen Rahmenbedingungen für die Arbeit erforderlich.

The Spiritual Approach to Systemic Family Therapies

The concept of spirituality has started being included in therapy settings due to the new paradigms showing developments in the world of psychology in the late 20th century and in the 21st century. When examining the literature, many articles and books are seen to have been published related to the topic, and most of the studies have been carried out abroad. These performed studies have contributed new concepts and information to the literature by revealing how the concept of spirituality can be integrated with family therapies. This study has been prepared for the purposes of drawing the attention of researchers who conduct studies in Turkey based on systemic family therapy and of specialists who plan therapy sessions based the relevant theory to the topic and to provide the literature with a topic that finds no examples in the literature of Turkey. How the concept of spirituality can be used in harmony with the systemic family therapy approach and what the techniques of the spirituality-based systemic family therapy are have been prepared by being based on the many studies that have been published abroad. Before beginning the study, theoretical information and basic concepts primarily about systemic family therapies are provided, and then it moves on to spirituality-oriented systemic family therapy by briefly mentioning the concept of spirituality. How the concept of spirituality can be applied to systemic family therapy and the points and ethical situations to which counselors need to pay attention are also mentioned. Lastly, sample cases are shared by providing information about the techniques of using religious stories and spiritual dialogue, these techniques being used in spirituality-oriented systemic family therapies.

El proceso de duelo desde la Terapia Familiar Sistémica: el papel del apego adulto

El objetivo del trabajo que se propone es realizar una investigación en torno a la bibliografía existente sobre el proceso de duelo en el contexto de la terapia familiar sistémica, con el fin de estudiar qué peso tienen variables como el apego, el sistema de creencias familiar. No hay dos procesos de duelo iguales ni dos familias que vivan esta situación de la misma manera, por ello, a la hora de abordar terapéuticamente la pérdida de un ser querido, es necesario atender a sus diferencias culturales, a su sistema de creencias característico, y a las posibles disfunciones que pudieran preexistir

My Journey as a Citizen Therapist

My story begins with the idealism of humanistic and family systems therapies of the 1970s, followed by disillusionment with making a difference in the larger world, and then the discovery of citizen therapist work. I describe my initial forays into direct community action and then two current projects on major social problems: police relationships with the African American community and political polarization in the Trump era. A key breakthrough along the way was coming to see my role as a citizen professional in a democracy—acting with community members rather than just for them.

Occurrence and comprehensive treatment of stress-related neurotic and somatoform disorders in students of different years and specialties

Topicality. Importance of current studies dealing with stress-related neurotic and somatoform disorders at a young age is determined by the necessity to find new forms of psychological support directed to social adaptation and harmonious personal development of students. Objective: to investigate occurrence of stress-related neurotic and somatoform disorders in students of different years and specialties, to develop a comprehensive treatment of the above conditions. Materials and methods. 1235 students underwent a comprehensive check-up during the period from 2015 to 2017 keeping to the principles of bioethics and deontology. The following methods were applied: clinical, clinical-psychopathological, clinical-epidemiological, clinical-anamnestic, experimental-psychological and statistical. Sampling did not differ considerably by the sex and age, place of residence, and form of education. The check-ups were performed in the period between examinations. Results. Investigation of the systematic sampling resulted in the fact that neurotic stress-related and somatoform disorders were found in 187 (15,14%) students that constituted 58,99% of all the nonpsychotic psychic disorders (NPD) diagnosed in young people. The nosology F 40.0-48.1 was found in 62 (33,16%) men and 125 (66,84%) women. The biggest amount of neurotic stress-related and somatoform disorders was diagnosed in the 1st and 3rd year students: 67,12% and 77,78% respectively (р<0,05). Those students studied on the specialties «General Medicine», «Stomatology», «Practical Psychology». Antidepressants, anxiolytics, anticonvulsive, nootropic agents, vitamins and various kinds of psychotherapy (cognitive-behavioral, systemic family, Gestalt, psychoanalysis, client-centered and body-focused therapy) were applied in the treatment of neurotic stress-related and somatoform disorders. Conclusions. The obtained results should be considered in making screening diagnostic, therapeutic and preventive measures for the students at higher educational institutions.

Longer-term effectiveness of systemic family therapy compared with treatment as usual for young people after self-harm: An extended follow up of pragmatic randomised controlled trial

BackgroundSelf-harm in adolescents is common and repetition frequent. Evidence for effective interventions to reduce self-harm is limited. Long term follow-up of existing studies is rare. MethodsExtended follow up, from 18 to at least 36-months, of the SHIFT trial: a pragmatic, multi-centre, individually-randomised, controlled trial involving young people (11–17) who had self-harmed at least twice and presented to Child & Adolescent Mental Health Services (CAMHS). SHIFT evaluated manualised family therapy (FT) versus treatment as usual (TAU) in reducing repetition of self-harm leading to hospital attendance 18 months post-randomisation.We obtained ONS mortality data, adult mental health data, and further details of hospital attendance from routine Hospital Episode Statistics (HES) data plus researcher follow-up. We assessed longer-term differences in outcome using multivariable Cox Proportional Hazards regression analysis, and assessed all-cause mortality and morbidity relating to hospital attendances for reasons other than self-harm. Study registrationISRCTN 59793150 OutcomesThe original sample of 832 were randomised between April 2010 and December 2013. Extended follow-up continued until February 2017 for a median 55·4 months (range 0–82·5 months), providing post 18-month data for 804 (96·6%) participants, of whom 785 (94·4%) had a minimum of 36-months follow-up.There was no evidence of a between-group difference in the primary outcome during the extended follow-up period (Hazard Ratio (HR) 1·03; 95% CI: 0·83, 1·28; p-value=0·78), consistent with our findings in the original trial with 18 months follow-up (HR 1·14, 95% CI 0·87, 1·49; p-value 0·33). There was a reduced rate of self-harm in older participants aged 15–17 (HR 0·7, 95% CI 0·56, 0·88), as compared with those aged 11–14; and significantly increased rates of self-harm in participants whose index episode combined self-injury and poisoning (HR 1·8, 95% CI 1·2, 2·7). Two deaths were reported during the extended follow up period. InterpretationFor adolescents referred to CAMHS after self-harm, having self-harmed at least once before, trial FT confers no benefits over TAU in reducing subsequent hospitalisation for self-harm over 18 months or 36 months. FundingNIHR HTA Reference: 07/33/01