Family Therapy Techniques Research Articles

Caregiver Engagement in Outpatient Treatment for Adolescents in Community Settings: Construct and Predictive Validity of Family Therapy Techniques.

Caregiver engagement and participation in community-based outpatient treatment services for adolescents is generally poor, which is problematic given the integral role of caregivers prescribed by evidence-based treatments across orientations. The current study explores the psychometric and predictive properties of a set of caregiver engagement techniques distilled from family therapy, used by community clinicians in routine care. It highlights relational engagement interventions and adds to growing work distilling core elements of family therapy. The study examined caregiver engagement techniques observed in 320 recorded sessions and outcome data from 152 cases treated by 45 therapists participating in one of three randomized trials investigating delivery of family therapy for adolescent behavior problems in community settings. Construct and predictive validity of caregiver engagement coding items were analyzed to understand the degree to which they cohered as a single factor and predicted outcomes in predictable ways. Results demonstrated item reliability and construct validity of a Caregiver Engagement Techniques factor. Greater use of these techniques was associated with decreased adolescent substance use. Unexpected results suggested greater use of techniques was associated with worsening internalizing symptoms and family cohesion per youth-report only. Post-hoc analyses revealed additional complexities in the association between engagement techniques and outcomes. Caregiver engagement practices tested in the current study represent a unified treatment factor that may contribute to positive therapeutic outcomes for adolescents in some clinical domains. Further research is needed to understand predictive effects.

21.4 Appreciating Differences: Navigating Intersectionality in Working With Gender-Expansive Youth and Their Families

Like all families, the families of gender-diverse youth present with beliefs, values, and patterns of interacting with others stemming from their lived experience of community, culture, and ethnicity. Appreciation of a family’s background and values can play an important role in helping family members to find common ground and enable them to provide the affirmation and support that is so important for improving mental health outcomes for gender-diverse youth. This can represent a significant challenge for child and adolescent psychiatrists, who often receive little training in incorporating cultural, ethnic, and religious differences in family therapy techniques and may struggle to address culturally based beliefs about gender identity and sexuality that differ from their own.

21.3 Use of Family Therapy in Working Toward Family Acceptance With Gender-Diverse Youth

Working with families of gender-diverse youth is a crucial part of their overall treatment plan, particularly when working in the context of a multidisciplinary Gender Clinic team. Attendees will leave with a better understanding of how to incorporate family therapy techniques into daily clinical practice when working with gender-diverse youth.

Utilizing Yoga Principles and Techniques in Experiential Family Therapy

The effects of yoga on mental health and general wellbeing are not a new research endeavor, as there are many studies that explore this topic. However, there is little literature on the integration of yoga within a therapeutic context. We seek to fill that gap and demonstrate the connections we see between the philosophies and practices of yoga and experiential family therapy specifically. First, we give a background of the origins of yoga and its use in psychotherapy thus far in addition to the essentials of Satir's experiential family therapy. We then connect these fields by discussing how they overlap both in beliefs and practices and by providing a case example that utilized techniques from both disciplines. We end with sharing our reflections surrounding implications to consider and our hopes for where this discourse could lead us in the future.

Pilot Trial of Online Measurement Training and Feedback in Family Therapy for Adolescent Behavior Problems

ABSTRACT Objective Pragmatic procedures for sustaining high-fidelity delivery of evidence-based interventions are needed to support implementation in usual care. This study tested an online therapist training system, featuring observational coder training and self-report fidelity feedback, to promote self-report acumen and routine use of family therapy (FT) techniques for adolescent behavior problems. Method Therapists (N = 84) from nine substance use and mental health treatment sites reported on 185 adolescent clients. Therapists submitted baseline data on FT technique use with clients, completed a workshop introducing the 32-week training system, and were randomly assigned by site to Core Training versus Core Training + Consultation. Core Training included a therapist coder training course (didactic instruction and mock session coding exercises in 13 FT techniques) and fidelity feedback procedures depicting therapist-report data on FT use. Consultation convened therapists and supervisors for one-hour monthly sessions with an external FT expert. During the 32 weeks of training, therapists submitted self-report data on FT use along with companion session audiotapes subsequently coded by observational raters. Results Therapist self-report reliability and accuracy both increased substantially during training. Observers reported no increase over time in FT use; therapists self-reported a decrease in FT use, likely an artifact of their improved self-report accuracy. Consultation did not enhance therapist self-report acumen or increase FT use. Conclusions Online training methods that improve therapist-report reliability and accuracy for FT use may confer important advantages for treatment planning and fidelity monitoring. More intensive and/or different training interventions appear needed to increase routine FT delivery.

Profile of Psychosocial Rehabilitation Centres for Persons with Substance Use Disorders in Bengaluru: A Cross-Sectional Study.

Substance use disorder is a major global health problem. There is limited information available about the pattern of utilization of psychosocial rehabilitation services (de-addiction service centres) for persons with substance use disorder. To study the profile of psychosocial rehabilitation centres (de-addiction service centres) for persons with substance use disorder in Bengaluru. To assess the staff profile, organisation profile, to examine the nature, types of treatment and psychosocial rehabilitation services offered by the de-addiction centers. Cross-sectional study design was used. Sample size: Out of 43 private organizations, 32 were eligible to participate. Out of 32, one-third (N=10) of the organizations participated in the study. Based on minimum standards of care manual for substance use disorders, an online questionnaire regarding organizational profile, staff pattern, nature and type of treatments, range of psychosocial rehabilitation services offered. Data was collected through online using google forms. Descriptive statistics such as frequency was used to analyse the data collected. All 10 organizations have a minimum one social worker, psychologist, nursing staff, and other supportive staff in the psychosocial rehabilitation centers. All the organizations have basic infrastructure and amenities as per minimum standards of care. Most organizations provide recovery oriented services, almost all organizations provide telephonic follow-up and home visit services. Most organizations provide psychosocial rehabilitation services. Most organization expressed need for training their counsellors on on group therapy and family therapy techniques. Most organisations possibly comply with a minimum standard of care and service, follow a twelve-step treatment approach, reintegrate the recovered clients in the community, provide an opportunity to work in their respective organisations. Most organisations have self-help (AA) groups, offer assistance programmes for family members, supportive educational groups and halfway-home care services.

Core Elements of Family Therapy for Adolescent Behavioral Health Problems: Validity Generalization in Community Settings

ABSTRACT Objective The core elements of family therapy for adolescent mental health and substance use problems, originally distilled from high-fidelity sessions conducted by expert clinicians, were tested for validity generalization when delivered by community therapists in routine settings. Method The study sampled recorded sessions from 161 cases participating in one of three treatment pools: implementation trial of Functional Family Therapy (98 sessions/50 cases/22 therapists), adaptation trial of Multisystemic Therapy (115 sessions/59 cases/2 therapists), and naturalistic trial of non-manualized family therapy in usual care (107 sessions/52 cases/21 therapists). Adolescents were identified as 60% male and 40% female with an average age of 15.4 years; 49% were Latinx, 27% White Non-Latinx, 15% African American, 3% another race/ethnicity, 6% race/ethnicity unknown. Session recordings (n = 320) were randomly selected for each case and coded for 21 discrete family therapy techniques. Archived data of one-year clinical outcomes were gathered. Results Confirmatory factor analyses replicated the factor structure from the original distillation study, retaining all four clinically coherent treatment modules comprised of all 21 techniques: Interactional Change (ICC = .77, Cronbach’s α = .81); Relational Reframe (ICC = .75, α = .81); Adolescent Engagement (ICC = .72, α = .78); Relational Emphasis (ICC = .76, α = .80). Exploratory analyses found that greater use of core techniques predicted symptom improvements in one treatment pool. Conclusions Core techniques of family therapy distilled from manualized treatments for adolescent behavioral health problems showed strong evidence of validity generalization, and initial evidence of links to client outcomes, in community settings.

Online Training of Community Therapists in Observational Coding of Family Therapy Techniques: Reliability and Accuracy.

A foundational strategy to promote implementation of evidence-based interventions (EBIs) is providing EBI training to therapists. This study tested an online training system in which therapists practiced observational coding of mock video vignettes demonstrating family therapy techniques for adolescent behavior problems. The study compared therapists ratings to gold-standard scores to measure therapist reliability (consistency across vignettes) and accuracy (approximation to gold scores); tested whether reliability and accuracy improved during training; and tested therapist-level predictors of overall accuracy and change in accuracy over time. Participants were 48 therapists working in nine community behavioral health clinics. The 32-exercise training course provided online instruction (about 15 min/week) in 13 core family therapy techniques representing three modules: Family Engagement, Relational Orientation, Interactional Change. Therapist reliability in rating technique presence (i.e., technique recognition) remained moderate across training; reliability in rating extensiveness of technique delivery (i.e., technique judgment) improved sharply over time, from poor to good. Whereas therapists on average overestimated extensiveness for almost every technique, their tendency to give low-accuracy scores decreased. Therapist accuracy improved significantly over time only for Interactional Change techniques. Baseline digital literacy and submission of self-report checklists on use of the techniques in their own sessions predicted coding accuracy. Training therapists to be more reliable and accurate coders of EBI techniques can potentially yield benefits in increased EBI self-report acumen and EBI use in daily practice. However, training effects may need to improve from those reported here to avail meaningful impact on EBI implementation.Trial Registration: The parent clinical trial is registered at www.ClinicalTrials.gov, ID: NCT03342872 (registration date: 11.10.17).

A Chinese family: teaching and learning in a clinical case conference

The authors show the interrelated processes of teaching and learning both for the Chinese student and the Western teacher. This article focuses on a clinical case conference as a co-constructed teaching and learning opportunity for Chinese therapists and Western teachers of family therapy. We present an account of a clinical case conference for family therapy students which occurred as part of a week-long training event, during the two-year continuous training programme in psychoanalytic couple and family therapy organised by Professor Fang Xin in Beijing. The first author, a Chinese family therapy student, made the family case presentation to her classmates and to the second author, a Western psychoanalyst as the discussant. The student introduced the referral to her of an index patient, a teenage boy who was refusing school, staying home to play videogames, and threatening suicide. She reported vividly on her consultation with the concerned mother, stern father, and rebellious adolescent son in a family group setting. Without process notes, the Western discussant could not comment on the presenter's analytic family therapy technique or move more deeply into the family unconscious. Yet, the material presented enabled the class to see how the boy had become the symptom bearer for his family, and at the same to learn about the strain of absence and the threat of death on a Chinese family. The article closes with a template for how to get the most out of a clinical case conference.

Family Experience of Safe: A New Intervention for Families of Children with a Diagnosis of Autism Spectrum Disorder

Systemic Autism-related Family Enabling (SAFE) is a new intervention for families of children with a diagnosis of Autism Spectrum Disorder (ASD). SAFE responds to international and national recommendations for improved care and the reported needs of families. SAFE draws from Family Therapy techniques, Attachment Narrative Therapy and known preferences of individuals with autism. Twenty two families of a child with a diagnosis of ASD severity level 1 or 2 were recruited. The families attended five 3-hour sessions. Family members completed the Helpful Aspects of Therapy Questionnaire (HAT) after each session. Analysis of the HAT data revealed that adults and children experienced SAFE to be helpful which was elaborated in terms of the following themes: therapist as helping reflection, increased understanding, feeling closer, more confident to reflect and problem solve, improved communication and feeling less alone and isolated. The findings are discussed to consider how SAFE can be improved and implemented to offer support for families. SAFE is a good candidate to fill a gap in autism related care.

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.

The role and value of family therapy for people living with cancer: a rapid review of recent evidence.

Cancer impacts the whole family and relational system, not just the individual with the diagnosis. The present article identifies and reviews publications in the field of family therapy and cancer since 2019, to describe the theoretical models and techniques applied, and the outcomes achieved. A search of databases and grey literature led to the identification of five articles from four studies. Four papers described primary research and one summarized a case example. Papers were published by teams in the USA, Sweden and Iceland. Each article described the benefits of adopting a family therapy approach on outcomes such as family communication, bereavement and decreased carer burden. Four papers described specialist family therapists delivering the interventions, and one used oncology nurses drawing on the theories and techniques of family therapy. The rarity of family therapy publications in the past year reflects the individual-level approach to cancer which permeates both medicine and talking therapies. The utility of family therapy could be further surfaced through more large-scale studies which thoroughly describe the unique theoretical basis and techniques, alongside outcomes for multiple people within the family system.

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.

Measurement training and feedback system for implementation of evidence-based treatment for adolescent externalizing problems: protocol for a randomized trial of pragmatic clinician training

BackgroundInnovations in clinical training and support that enhance fidelity to evidence-based treatment (EBT) for adolescent behavior problems are sorely needed. This study will develop an online training system to address this gap: Measurement Training and Feedback System for Implementation (MTFS-I). Using procedures intended to be practical and sustainable, MTFS-I is designed to increase two aspects of therapist behavior that are fundamental to boosting EBT fidelity: therapist self-monitoring of EBT delivery, and therapist utilization of core techniques of EBTs in treatment sessions. This version of MTFS-I focuses on two empirically supported treatment approaches for adolescent conduct and substance use problems: family therapy and cognitive behavioral therapy (CBT).Methods/designMTFS-I expands on conventional measurement feedback systems for client outcomes by adding training in observational coding to promote EBT self-monitoring and focusing on implementation of EBT treatment techniques. It has two primary components. (1) The training component, delivered weekly in two connected parts, involves self-monitored learning modules containing brief clinical descriptions of core EBT techniques and mock session coding exercises based on 5–8 min video segments that illustrate delivery of core techniques. (2) The feedback component summarizes aggregated therapist-reported data on EBT techniques used with their active caseloads. MTFS-I is hosted online and requires approximately 20 min per week to complete for each treatment approach. This randomized trial will first collect data on existing delivery of family therapy and CBT techniques for youth in outpatient behavioral health sites (Baseline phase). It will then randomize site clinicians to two study conditions (Implementation phase): Training Only versus Training + Feedback + Consultation. Therapists will choose whether to train in family therapy, CBT, or both. Study aims will compare clinician performance across study phase and between study conditions on MTFS-I uptake, reliability and accuracy in EBT self-monitoring, and utilization of EBT techniques in treatment sessions (based on observer coding of audiotapes).DiscussionStudy contributions to implementation science and considerations of MTFS-I sustainability are discussed.Trial registrationClinicalTrials.gov, NCT03722654. Registered on 29 October 2018.

52.3 TRANSCENDING CULTURAL BARRIERS IN WORKING WITH GENDER-EXPANSIVE YOUTH AND THEIR FAMILIES

Similar to all families, the families of gender-diverse youth present with beliefs, values, and patterns of interacting with others stemming from their lived experiences of community, culture, and ethnicity. Appreciation of a family’s background and values can play an important role in helping family members to find common ground and enable them to provide affirmation and support, which are very important in improving mental health outcomes for gender-diverse youth. This can represent a significant challenge for child and adolescent psychiatrists, who often receive little training in incorporating cultural and ethnic differences in family therapy techniques and may struggle to address culturally based beliefs about gender identity and sexuality that differ from their own. Attendees will leave with an increased awareness of cultural factors that can affect family acceptance and ideas for approaches to help mitigate difficulties.

52.1 WORKING TOWARD FAMILY ACCEPTANCE WITH FAMILIES OF GENDER-DIVERSE YOUTH

Working with families of gender-diverse youth is a crucial part of their overall treatment plan, particularly when working in the context of a multidisciplinary gender clinic team. Attendees will leave with a better understanding of how to incorporate family therapy techniques into daily clinical practice when working with gender-diverse youth.

Measurement Training and Feedback System for Implementation of family-based services for adolescent substance use: protocol for a cluster randomized trial of two implementation strategies

BackgroundThis article describes a study protocol for testing the Measurement Training and Feedback System for Implementation (MTFS-I) and comparing two implementation strategies for MTFS-I delivery. MTFS-I is a web-based treatment quality improvement system designed to increase the delivery of evidence-based interventions for behavioral health problems in routine care settings. This version of MTFS-I focuses on family-based services (FBS) for adolescent substance use. FBS, comprising both family participation in treatment and family therapy technique use, have achieved the strongest evidence base for adolescent substance use and are a prime candidate for upgrading treatment quality in outpatient care. For FBS to fulfill their potential for widespread dissemination, FBS implementation must be bolstered by effective quality procedures that support sustainable delivery in usual care.Methods/designAdapted from measurement feedback systems for client outcomes, MTFS-I contains three synergistic components: (a) weekly reporter training modules to instruct therapists in reliable post-session self-reporting on FBS utilization; (b) weekly mock session videos of FBS interventions (5–8 min) for supportive training in, and practice coding of, high-quality FBS; and (c) monthly feedback reports to therapists and supervisors displaying aggregated data on therapist-reported FBS use. MTFS-I is hosted online and requires approximately 20 min per week to complete. The study will experimentally compare two well-established implementation strategies designed to foster ongoing MTFS-I usage: Core Training, consisting of two 3-h training sessions focused on FBS site mapping, selecting FBS improvement goals, and sustaining MTFS-I, followed by routine remote technical assistance; and Core + Facilitation, which boosts Core Training sessions with collaborative phone-based clinical consultation and on-site facilitation meetings for 1 year to promote FBS goal achievement. The study design is a cluster randomized trial testing Core Training versus Core + Facilitation in ten substance use treatment clinics. Study aims will compare conditions on MTFS-I uptake, FBS delivery (based on therapist-report and observational data), and 1-year client outcomes.DiscussionStudy contributions to implementation science and considerations of MTFS-I sustainability are discussed.Trial registrationClinicalTrials.govNCT03342872. Registered 10 November 2017

Family therapy techniques and one-year clinical outcomes among adolescents in usual care for behavior problems.

This study tested whether use of family therapy (FT) techniques predicted long-term clinical outcomes in usual care for adolescents enrolled in either family-based or non-family-based treatment for conduct and substance use problems. Participants included 70 adolescents (53% female; mean age 15.4 years) from diverse backgrounds (64% Hispanic, 16% African American, 11% multiracial) assessed at baseline and 3-, 6-, and 12-month follow-up. Utilization of FT techniques was assessed for 802 therapy sessions via a therapist-report tool that collected postsession data on delivery of core treatment techniques of the FT approach. Latent growth curve modeling was used to examine individual change over 12-month follow-up. FT technique scores, averaged across treatment sessions, were included as a predictor in latent growth models, controlling for adolescent age, sex, and ethnicity. More extensive use of core FT techniques predicted significant decreases in adolescent-reported delinquency and externalizing behavior and marginal decreases in substance use and parent-reported externalizing for cases in both family and nonfamily treatment. Greater use of FT techniques in routine care was associated with better long-term adolescent outcomes, regardless of whether clients attended services featuring family therapy or an alternative treatment approach. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An Intersectional Approach to Therapy with Transgender Adolescents and Their Families.

In recent years, transgender individuals have experienced both greater visibility and increased discrimination, such as direct discriminatory practices and removal of Obama-era protections for transgender students. Minority stress theory suggests that discrimination toward gender identity is related to poor mental health outcomes. This hypothesis is supported by the literature regarding transgender adults and adolescents; notably, familial rejection is highlighted as having a strong association with negative outcomes. The field of psychology has continued to explore best practices in approaches to family therapy with transgender individuals. Gender-affirming techniques have gained momentum, largely due to a recognized need for therapy techniques that aim to cultivate familial support for this vulnerable population. As transgender individuals and their families hold many social identities, including race, ethnicity, socioeconomic status, and gender, affirming family therapy involving transgender individuals must explore ways in which gender identity intersects with and is understood in context of family members' other identities. In particular, we must explore how identities may serve to bolster or impede therapeutic processes targeting acceptance. The current article aims to raise awareness of a need for an intersectional approach with gender-affirming family therapy techniques. We detail ways intersectionality can inform therapy practice and provide case examples from our work with a diverse group of transgender adolescents and their families.

39.1 Working Toward Family Acceptance With Families of Gender Diverse Youth

Working with families of gender-diverse youth is a crucial part of their overall treatment plan, particularly when working in the context of a multidisciplinary gender clinic team. Attendees will leave with a better understanding of how to incorporate family therapy techniques into daily clinical practice when working with gender-diverse youth.