Focal family therapy outcome study. I: Patient and family functioning

This pilot study compared the efficacy of two models of family therapy plus medication in the treatment of ten schizophrenic patients previously considered poor responders to neuroleptics alone. Focal Family Therapy (FFT), a limited psychodynamic model, was compared with Supportive Management Counselling (SMC), an educative, problem-solving approach. Family treatment was begun during admission to hospital and continued for up to six months post-discharge. Patient and family measures were administered on assessment, termination, and at three, six and 12 month follow-up interviews. Our data suggest that patients in both groups improved significantly following treatment on measures of social functioning and community tenure. The average increase in amount of time out of hospital was a full year, compared to previous rates. Patients receiving FFT demonstrated significantly greater improvement in symptoms, compared to patients in the SMC group. On average, families scored in the normal range on the family functioning measure at assessment and upon termination of treatment.     

Alliance rupture and repair in conjoint family therapy: an exploratory study

In this article, we introduce a methodology for studying alliance rupture and repair in conjoint family therapy. Using the System for Observing Family Therapy Alliances (Friedlander, Escudero, & Heatherington, 2006), we identified rupture markers and repair interventions in a session with a single mother and her 16-year-old "rebellious" daughter. The session was selected for analysis because a severe rupture was clinically evident; however, by the end of the session, there was an emotional turnaround, which was sustained in the following session and continued until the successful, mutually agreed upon termination. The first rupture occurred when the psychotherapist suggested that the mother explore, in an individual session, how her "personal stress" may be affecting her daughter. The observational analysis showed repeated rupture markers, that is, confrontation and withdrawal behavior, hostile within-family interactions, and a seriously "split" alliance in family members' expressed feelings toward the psychotherapist. The time-stamped behavioral stream showed that the psychotherapist focused first on safety, then on enhancing his emotional connection with each client, and finally on helping mother and daughter understand each other's behavior and recognize their shared isolation.     

Stress-related immune suppression: health implications

This study used a year-long prospective design to assess linkages among distress, immunity, and illness. Serial blood samples were collected from 40 first-year medical students at the first, third, and fifth examination periods, as well as 1 month before each. There were significant decrements in the production of gamma-interferon by concanavalin A-stimulated lymphocytes obtained at the time of examinations. Antibody titers to Epstein-Barr virus (EBV) increased during examination periods, suggesting reactivation of latent EBV and therefore poorer cellular immune control of latent virus. We obtained data that suggest that T-cell killing by memory T lymphocytes of EBV transformed autologous B lymphocytes also declined during examination periods. The activity of a lymphokine, leukocyte migration inhibition factor, normally suppressed during recrudescence of herpes simplex virus type 2 infections, was altered during examination periods and an increase in both plasma and intracellular levels of cyclic AMP associated with examination stress was observed. An increase in the incidence of self-reported symptoms of infectious illness was also associated with examination periods. The data support the linkage between stress-related immunosuppression and health.     

Group parent training versus individual family therapy: An outcome study

A simple of 15 families referred for child behavior problems were randomly assigned to a group condition (parent training plus group behavior therapy , n = 7), and an individual condition (individual family behavior therapy, n = 8). These children manifested primarily home problems of non-compliance, tantrums and fighting behaviors. Results showed the group condition was more efficient in terms of therapist time and number of subject-families achieving an experimental criterion for behavior change. The group condition scored significantly higher than the individual condition on a post-test measuring knowledge of behavioral principles as applied to children. Most subjects, regardless of treatment condition, rated non-targeted behaviors as decreasing in frequency. Also, both groups were equally satisfied with therapy. Families were contracted 6 months following the conclusion of treatment.     

Attachment-based family therapy for depressed adolescents: a treatment development study

OBJECTIVE: To design a treatment manual and adherence measure for attachment-based family therapy (ABFT) for adolescent depression and to collect pilot data on the treatment's efficacy. METHOD: Over a period of 2 years, 32 adolescents meeting criteria for major depressive disorder (MDD) were randomly assigned to 12 weeks of ABFT or a 6-week, minimal-contact, waitlist control group. The sample was 78% female and 69% African American; 69% were from low-income, inner-city communities. RESULTS: At post-treatment, 81% of the patients treated with ABFT no longer met criteria for MDD, in contrast with 47% of patients in the waitlist group. Mixed factorial analyses of variance revealed that, compared with the waitlist group, patients treated with ABFT showed a significantly greater reduction in both depressive and anxiety symptoms and family conflict. Of the 15 treated cases assessed at the follow-up, 13 patients (87%) continued to not meet criteria for MDD 6 months after treatment ended. CONCLUSIONS: ABFT appears to be a promising treatment and worthy of further development.     

系统家庭治疗前后精神障碍患者家庭动力学变化及其与疗效的 …

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Stress-related depression: Neuroendocrine,genetic, and therapeutical aspects

Objective. To summarize current concepts on neuroendocrine and genetic principles underlying stress-related depression and to discuss the challenges of personalized treatment in depression. Methods. Review of the literature pertaining to genetic and neuroendocrine basis of stress-related depression including aspects of treatment response with a focus on the hypothalamus-pituitary-adrenal (HPA) axis. Results. There is increasing evidence that genetic polymorphisms and dysregulation of the HPA axis are associated with the pathophysiology of stress-related depression. Individual stress hormone reactivity seems to be determined by a combination of genetic and environmental factors, contributing to both, resilience or vulnerability. Conclusions. Although substantial progress has been made, current knowledge is still limited. Further basic and clinical research is needed to identify specific subgroups and to minimize heterogeneity of the depression phenotype. A better characterization is essential to detect genetic and functional predictors of antidepressant treatment response to follow the vision of personalized therapy in psychiatry.     

Integrated family and individual therapy for bipolar disorder: results of a treatment development study

BACKGROUND: Several studies have established the efficacy of psychosocial interventions as adjuncts to pharmacotherapy in the symptom maintenance of bipolar disorder. This study concerned a new psychosocial approach - integrated family and individual therapy (IFIT) - that synthesizes family psychoeducational sessions with individual sessions of interpersonal and social rhythm therapy. METHOD: Shortly after an acute illness episode, 30 bipolar patients (DSM-IV criteria) were assigned to open treatment with IFIT (up to 50 weekly sessions of family and individual therapy) and mood-stabilizing medications in the context of a treatment development study. Their outcomes over 1 year were compared with the outcomes of 70 patients from a previous trial who received standard community care, consisting of 2 family educational sessions, mood-stabilizing medications, and crisis management (CM). Patients in both samples were evaluated as to symptomatic functioning at entry into the project and then every 3 months for 1 year. RESULTS: Patients in IFIT had longer survival intervals (time without relapsing) than patients in CM. They also showed greater reductions in depressive symptoms over 1 year of treatment relative to their baseline levels. The results could not be explained by group differences in baseline symptoms or pharmacologic treatment regimens. CONCLUSION: Combining family and individual therapy with medication may protect episodic bipolar patients from early relapse and ongoing depressive symptoms. Further examination of this integrative model within randomized controlled trials is warranted.     

Vector therapy in family therapy

Summary Family psychiatry has evolved as a new system for the organization of psychiatric practice; it takes the family group rather than the individual as the functional unit.In therapy, as in all other aspects of family psychiatry, the family is the unit. Family Therapy includes all procedures for the treatment of the family and can be divided into Family Psychotherapy and Vector Therapy, the subject of this communication.A vector denotes a quantity which has direction. Force, including emotional force, is a quantity with direction, and therefore can be represented by a vector. Furthermore, as direction is a property of a vector, and direction implies movement, it results in a dynamic situation. The individual can be regarded as an element in the family's field of emotional forces, and both the individual and the family as elements in the community's field of emotional forces.Vector therapy is concerned with evaluating these forces and readjusting their patterning within the life space to produce a more harmonious field of emotional forces within and around the family.

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Zusammenfassung Familienpsychiatrie hat sich als ein neues Organisationssystem der psychiatrischen Praxis entwickelt. Sie nimmt als funktionale Einheit mehr die Familiengruppe als das Individuum.In der Therapie ist die Familie, wie in allen anderen Formen der Familienpsychiatrie, die Einheit. Familientherapie schließt alle Behandlungsverfahren für die Familie ein und kann in Familienpsychotherapie und Vektortherapie, dem Gegenstand dieser Mitteilung werden.Ein Vektor bedeutet eine Quantität mit einer bestimmten Richtung. Kraft, einschließlich emotionaler Kraft, ist eine Quantität mit einer Gerichtetheit und kann daher durch einen Vektor dargestellt werden. Da Gerichtetheit eine Eigenschaft eines Vektors ist und Bewegung einschließt, folgt weiterhin daraus eine dynamische Situation. Der Einzelne kann als ein Element im emotionalen Kräftefeld der Familie gesehen werden und beide — der Einzelne und damit die Familie — als Elemente im emotionalen Kräftefeld der Gemeinde.Vektortherapie befaßt sich mit der Bestimmung dieser Kräfte und ihrer Neuordnung innerhalb des Lebensraumes, um ein harmonischeres Feld der emotionalen Kräfte innerhalb der Familie und um sie herum herzustellen.

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Résumé La psychiatrie de famille est devenue un nouveau système dans l'organisation de la pratique psychiatrique; c'est le groupe familial plutôt que l'individu qui est considéré comme unité fonctionnelle.En thérapie comme dans tous les autres aspects de la psychiatrie de famille, la famille est l'unité. La thérapie de famille comprend tous les modes de traitement de la famille et peut être divisée en psychothérapie de famille et thérapie vectorielle, cette dernière étant le sujet de ce travail.Un vecteur indique une quantité et une direction. La force, y compris la force émotionnelle, est une quantité et une direction; elle peut par conséquent être représentée par un vecteur. De plus, la direction étant une propriété du vecteur et la direction impliquant un mouvement, il en résulte une situation dynamique. L'individu peut être considéré comme un élément dans le champ familial des forces émotionnelles, et l'individu et la famille tous deux comme des éléments dans le champ communautaire des forces émotionnelles. La thérapie vectorielle consiste à évaluer ces forces et à les réajuster afin de créer un champ de forces émotionnelles plus harmonieux au sein et autour de la famille.

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Based on paper given at the International Congress of Psychotherapy, Wiesbaden 1967.     

Culture and family therapy.

Children and families constitute an ever-increasing culturally diverse group in this country. Together with incentives in multicultural education and the evidence of the impact of different cultural values in the media, these groups have become more visible, more complex, and harder to study. Culture is defined as dynamic and expressive of shared values and behaviors. Cultural patterns may be situation specific and change according to contextual demands (rural versus urban youth) or may be population specific (the culture of gay youth versus heterosexual youth). Some people also ascribe to cultural beliefs, but these do not necessarily translate to behaviors. Families and their children vary in their level of acculturation and developmentally vary in their level of ethnic identification. Child-rearing patterns and parenting approaches are constantly in flux, as are gender roles and, increasingly, religious affiliations. Clinicians are challenged to treat these families and often find the cultural dissonance with their own native culture and theoretical approaches as obstacles for the appropriate assessment and treatment interventions. As the field of family therapy has developed, so have culturally sensitive and competent approaches in the field of mental health. These approaches must be integrated into the multiplicity of other factors that define normality and psychopathology and be studied further in the context of their relevance and efficacy for special groups of children and families who suffer with specific disorders. In the meantime, cultural awareness and competence will continue to help clinicians understand better the impact of values and patterns in family cycles, family organization, child-rearing practices, and the expression of symptoms in family systems.     

A randomized controlled study of cognitive behavior therapy and behavioral family therapy for anorexia nervosa patients

Very few studies have examined the role of cognitive behavior therapy (CBT) in the outpatient treatment of anorexia nervosa. This study used a randomized, controlled design to evaluate a 12-month, manual based program of CBT, with behavioral family therapy as the comparison group. Twenty-five adolescents and young adults with anorexia nervosa, currently living with their families, were recruited into the study with both treatment groups receiving 21-25 sessions of therapy. Outcome measures included nutritional status, eating behaviors, mood, self-esteem, and family communication. Sixty percent of the total sample and 72% of treatment completers had “good” outcome (defined as maintaining weight within 10% of average body weight and regular menstrual cycles) at post-treatment and at six months follow-up. No significant differences between treatment groups were found and the majority of patients did not reach symptomatic recovery. While limited by the small sample size, the findings compliment and extend previous research.     

Child versus family cognitive-behavioral therapy in clinically anxious youth: an efficacy and partial effectiveness study

ObjectiveThe efficacy and partial effectiveness of child-focused versus family-focused cognitive-behavioral therapy (CBT) for clinically anxious youths was evaluated, in particular in relation to parental anxiety disorders and child's age.MethodClinically referred children with anxiety disorders (N = 128) and their parents were randomly assigned to child or family CBT and evaluated at pretreatment, posttreatment, and 3-month follow-up. Twenty-five families were measured before and after a 2- to 3-month waitlist period.ResultsNone of the waitlisted children recovered from their anxiety disorders. In contrast, 41% of the treated children no longer met criteria for any anxiety disorder after CBT, and 52% demonstrated continued improvement at the 3-month follow-up. Significantly more children were free of anxiety disorders (53%) in the child CBT condition compared with family CBT condition (28%) at posttreatment, whereas at 3-month follow-up, the superior effect of child CBT was no longer significant. Similar results were obtained from the questionnaire measures. Both child and family CBT were less effective if parents had an anxiety disorder themselves. On some of the measures, child CBT was superior if parents had anxiety disorders themselves, whereas family CBT was superior if parents had no anxiety disorders. Finally, younger children had better outcomes than older children, regardless of the treatment condition.ConclusionsOverall, child CBT seems slightly more beneficial than family CBT. Because this study was conducted in a clinical setting with clinically referred children, results indicate partial effectiveness for child CBT.