Attachment-based family therapy: adherence and differentiation

This study examined the fidelity of attachment-based family therapy (ABFT) for depressed adolescents. Trained observers used the therapist behavior rating scale (3rd version) to code therapist behaviors in 45 sessions of ABFT and 45 sessions each from two empirically based treatments for adolescent substance abusers: multidimensional family therapy (MDFT) and cognitive-behavioral therapy (CBT). Results indicate that ABFT therapists employed essential ABFT interventions, such as focusing on vulnerable affect, highlighting attachment-related themes, and promoting adolescent-parent reattachment through in-session enactments. In accordance with the sequential nature of the treatment, these interventions were used more extensively during the early stage of treatment, when there is a greater focus on reattachment. ABFT was perfectly discriminable from CBT, with ABFT therapists using more restructuring and reattachment interventions and CBT therapists using more signature CBT interventions, such as cognitive monitoring and homework. ABFT was also discriminable from MDFT, with ABFT therapists placing a greater emphasis on reattachment. These results suggest that ABFT is a viable and differentiated treatment. Together with prior findings supporting its efficacy, ABFT should be considered a promising new approach for working with depressed adolescents and their families.     

SYSTEMIC TREATMENT OF SUBSTANCE ABUSE: A GRADUATE COURSE

Today, family therapists should have an understanding of the development and maintenance of substance abusing patterns in families. In this paper, the authors describe a graduate course for teaching therapists about the contributions that have been made to the understanding and treatment of substance abuse by family researchers, theorists and clinicians. Course purpose, student selection, instructional methods and course content are delineated.     

AN ALTERNATIVE TO MANAGED CARE: A "GUILD" MODEL FOR THE INDEPENDENT PRACTICE OF PSYCHOTHERAPY

As health care is reconfigured by HMOs and managed care organizations, family therapists often have to decide whether or not to cooperate with the new power structures and their ways of doing things. The chief concern of many therapists is the ehtical bind created when the managed care orgranization demands breaches of confidentiality or makes decisions about the course of treatment that may not, in the therapist's opinion, be in the best interest of the family. Associations of independent, nonmanaged care psychotherapists are springing up in response to these dilemmas. This paper describes the philosophical evolution and organizational development of one such association.     

HIV and family therapists' duty to warn: a legal and ethical analysis

In the absence of definitive legal precedents, family therapists must decide whether to warn sexual partners of HIV-positive clients when clients themselves refuse to do so. Deciding whether to break confidentiality reaises both legal and ethical issues. Legally, the Tarasoff ruling requires therapists to warn potential victims of illegal dangers posed by clients but does not require therapists to warn potential victims of dangers posed by their clients' legally permissible actions. unless the behavior of the seropositive client is proscribed by state law, warning the clients' partners does not fall within the scope of the Tarasoff ruling. Ethically, therapists must negotiate and adhere to a disclosure policy that balances considerations of respecting autonomy, maintaining integrity (avoiding fraud and betrayal), benefiting clients, and fostering responsibility. Some therapeutic and ethical aspects of these considerations are discussed.     

42 CFR Part 2 final rule: OTP input into PDMP,more enforcement and easier

The final rule “modernizing” the country's confidentiality regulation, which originally required treatment providers to obtain patients' consent in writing to the release of their substance use disorder (SUD) treatment information, was published last week. Consent for release of information would apply to a broad category of health care operations, care coordination and case management. And methadone patients could have their treatment information put into state data systems; since 2011, that has not been allowed. Finally, the freedom of law enforcement to place and use confidential informants inside treatment programs has been expanded.     

FAMILY THERAPISTS' RESPONSE TO AIDS: AN EXAMINATION OF ATTITUDES,KNOWLEDGE, AND CONTACT*

As the number of individuals and families impacted by AIDS continue to multiply, family therapists will increasingly be asked to become engaged in the challenge of caring for those affected. To date, little has been written in family therpy journals regarding the response of family therapists to this crisis. This paper represents an initial attempt to examine the atitudes of clinical members of the American Association for Marriage and Family Therapy toward AIDS and persons with AIDS. Included in the study are data regarding the therapists' contact with persons with AIDS, gays, and lesbians, and the impact of such contact on attitudes. Implications for future research, training, and treatment of those affected by AIDS are also provided.     

Getting reluctant substance abusers to engage in treatment/self-help: a review of outcomes and clinical options

This review examines the results from 19 outcome studies, involving 1,501 cases, within 10 different clinical approaches to getting alcohol or drug abusers to engage in treatment or self-help. Each approach is summarized and its "success rate(s)" presented. Comparisons are made across various subcategories, such as alcohol vs. drug abusers, adolescents vs. adults, and experimental conditions vs. controls. A distinction is drawn between "Dual-Purpose" approaches, which combine engagement with counseling of the concerned person who originally sought help for the substance abuser, and "Engagement-Primary" approaches, which generally confine their efforts (through working with family members and others) to getting the substance abuser into treatment/self-help. "Best bet" clinical options are presented in terms of which particular approach appears to have the edge with which kind of substance abuser.     

Initial findings from Parent Party Patrol: an intervention to reduce adolescent substance use through reduced involvement in unchaperoned parties

This article presents preliminary evaluation findings from Parent Party Patrol (PPP). PPP is a two-hour single-session intervention that provides information to parents about ways to increase monitoring and improve communication and family guidelines regarding substance use, with the goal of reducing adolescent involvement in unsupervised activities and associated substance use. Seventy-three attendees from 15 PPP sessions completed baseline and three- to six-month follow-up information. At follow-up, participants showed significantly increased awareness of adolescent substance use and unchaperoned activities, improved communication and use of family guidelines regarding substance use, and increased monitoring of their children's activities. A significant reduction in adolescent attendance at unchaperoned parties was also reported. Replication of the study with a larger, more representative sample and controlled design is suggested. As adolescent substance use is a multidetermined problem, PPP may be best viewed as one part of a broader comprehensive substance abuse prevention program.     

Therapeutic change in Colombian families dealing with violence: therapists, clients, and referring systems in conversation

There is a gap in the Marriage and Family Therapy literature regarding clients', therapists', and family judges' theories of change in relational therapy for family violence. We conducted in-depth interviews with eleven court-referred families, their therapists, and two family judges in Bogota, Colombia. Interviews focused on their expectations of therapy outcomes, their understanding of change, and their evaluation of individual and relational therapy outcomes. We followed a grounded theory approach to data analysis. Analyses showed that therapists, family judges, and clients hold different expectations and theories regarding therapeutic change. Findings are discussed based on existing research on clients' and therapists' ideas about change. Implications for future research and practice are presented.     

Conceptualizing and Treating Problem Gambling as a Family Issue

Few family therapists have training in the identification, assessment, and treatment of problem gambling and its impact on couple and family relationships. The authors conceptualize problem gambling (PG) as a family issue and encourage clinicians and researchers to pay attention to the systemic antecedents and consequences of PG on family relationships. A review of the literature and clinicians' experiences regarding the impact of PG on couple and family relationships are presented and discussed. In light of the limited systemic-based treatments for PG, marriage and family therapists are urged to begin paying attention to this emerging issue that has significant couple and family ramifications.     

Ethics and family therapy: the case management of family violence*

All family therapists, and especially Milan-style systemic therapists, have been trained to take a neutral stance regarding family issues, based on a circular causality model of family interaction. Therefore, when therapists deal with family violence, their ability to perceive individual responsibility for unethical behavior is weakened or suppressed. In fact, this ability is the primary tool in developing effective treatment planning in cases of family violence: The actively physically abusive man needs to be in individual and/or group therapy, not conjoint or family therapy. The ethical judgment of the therapist is what determines the limits of family therapy.     

Severity of impairment in dually addicted gamblers

While much information about pathological gamblers has been gathered from clinical observations, few data exist from systematic, objective studies. Furthermore, still less is known about that subset of pathological gamblers who are also chemically dependent and/or substance abusers. Previous studies (e.g., McCormick et al., 1984) report that up to 45% pathological gamblers are substance abusers. The present study hypothesizes that inpatient chemically dependent pathological gamblers will exhibit greater impairment on a variety of life-functioning measures than a comparable group of chemically dependent psychiatric inpatient. Twelve chemically dependent pathological gamblers were matched on the basis of age, sex, alcohol/drug history and occupational status with twelve chemically dependent persons with no pathological gambling history. All study members were inpatients in an addictions program at a private psychiatric hospital. Each patient was administered the Addiction Severity Index (ASI) to assess impairment in seven problem areas: medical, employment/support, alcohol, drug, legal, family/social, and psychological/psychiatric functioning. The following findings emerged: 1) Chemically dependent (CD) gamblers report more chronic medical problems than CD psychiatric patients; 2) CD gamblers report more frequent conflicts with relatives and family members than CD psychiatric patients; 3) CD gamblers report more psychiatric symptoms both in amount and duration; Although not reaching statistical significance, 42% of the CD gamblers had made a previous suicide attempt as compared to 8% of the CD psychiatric patients; 4) CD gamblers and CD psychiatric patients appear comparable with regard to employment functioning and amount of legal problems. The clinical and theoretical implications of these findings are discussed further.     

Integrating Reflective Practice in Family Therapy Supervision

This paper discusses how to integrate reflective practice in the family therapy supervisory relationship. This enables family therapists to think creatively, be insightful, and develop a range of perspectives regarding systemic formulation and practice. It encourages review of the past and promotes understanding in the present with the aim to improve therapists work with families in the future. Reflective practice encourages independent thinking and learning and helps therapists to develop a systemic process of critical enquiry to investigate and critique their own practice. It encourages therapists to be self‐reflective and develop confidence to think hypothetically regarding change. This allows them to pose questions for exploration, construct a new lens to conceptualise therapy and the therapeutic relationship and develop awareness of the personal as well as the professional self.     

Women Survivors Confronting Their Abusers:

This article presents data from a longitudinal study of 72 women who entered therapy in the mid-1980s to deal with the longterm consequences of childhood sexual abuse. Voluntary participants, who were initially reached through their therapists, were surveyed in 1986, 1988, and 1992. With the help of their therapists, the women whose abusers were alive and available faced the questions of whether to confront them, and if so, when and how. In general, responses to the first survey were characterized by a desire to confront without the readiness to do so, responses to survey two by completed confrontations, and responses to survey three by reconfrontations. Findings supported recommendations regarding helping clients to plan, practice, and carry out confrontations safely. They also showed that more recognition should be given to the aftermath of confrontation, debriefing, and reconfrontation, and to survivors with specialized needs, such as women formerly amnesic to their abuse. Clinical implications of these findings and recommendations for clinicians are discussed.     

Patient Rights: An Advocate's Perspective

Abstract

The current growing concern about patients' rights and the delivery of student health care precipitates an environment of fear, distrust, and uneasiness within university health services. This paper addresses several selected clinical, ethical, and legal issues which have come into conflict during recent years. Our examination surveys ethical and legal principles of confidentiality, defines areas in which breaches are most likely to occur, and suggests ways of preventing breaches of confidence between students and health services.

While the fundamental ethical principle underlying confidentiality is the individual's right of privacy, many issues of confidentiality are extremely difficult to resolve. University health services have expanded the concept of health care to encompass all the conditions — medical, emotional, social, economic and environmental — which affect the health of students. As a result, health service administrators should be fully aware of the laws and associated legal complexities in their own state which affect confidentiality. Furthermore, student health physicians, and particularly mental health therapists must be sensitive to needs for protecting the privacy of students.

Legal principles of confidentiality discussed in this paper with respect to specific problem situations which might arise in a student health center include: 1) right to privacy; 2) privileged communications; 3) releasing information from the medical record; 4) releasing information to the student; and 5) treating minors without parental consent. Finally, in addition to the responsibilities which must be assumed by the health professional, certain student responsibilities in the selection and utilization of health professionals are recommended.     

Developing culturally competent marriage and family therapists: guidelines for working with Hispanic families

As the Hispanic population of the United States continues to grow, so will the need for therapists who have been trained to work with Hispanic families. This content analysis of the available treatment literature generated several specific guidelines that can be used in training and evaluating culturally competent therapists. Guidelines included: Use family therapy, act as advocate for the family, assess immigration experience, assess acculturation, respect father, interview family subsystems separately, do not force changes, provide concrete suggestions, and warmly engage the family. Empirical and conceptual support for each guideline is discussed and several conclusions are made regarding culturally competent therapy with Hispanic families.     

Using expressive arts in relapse prevention of young psychotropic substance abusers in Hong Kong

Art therapy has been empirically assessed as an effective form of relapse prevention for substance abusers who are relatively treatment resistant, defensive and unexpressive. In Hong Kong, the use of expressive arts in substance abuse treatment and relapse prevention programs has become increasingly popular in both residential and community-based services. However, unlike in the West, no empirical research has yet been conducted to validate and assess the effectiveness of such therapy within a Hong Kong context. This study adopted a two-group pre- and post- with 6-month follow-up experimental design to examine the effectiveness of an art-based relapse prevention group compared with a cognitive–behavioral relapse prevention group for young psychotropic substance abusers in a community-based outpatient service. The study included both a quantitative questionnaire and qualitative in-depth interviews with each participant. With 6 members in each of the group, only the qualitative data were discussed. The qualitative data revealed that the art-based relapse prevention group was particularly effective for the male participants, who were less verbal and sociable or had a strong sense of inadequacy and guilt about their delinquent behavior. In the experience of the participants, ‘family’ was a double-edged sword in terms of their growth and development. They had no choice but the victims bearing the lack of guidance and sense of loneliness in family conflicts or divorces. However, at the same time, family care, love and support were the greatest motivating factors to keep them abstinent. Therefore, the integration of art- and family-based interventions in drug relapse prevention programs is highly recommended.     

Perspectives of college students and their primary health care providers on substance abuse screening and intervention

The authors conducted a needs assessment among students and health-care providers of a southwestern university health center with the goal of developing health-care-provider training addressing substance-abuse screening and intervention. They collected data from focus groups of undergraduate students and structured interviews and questionnaires with health-care providers. They identified gaps in provider and student perspectives on the extent of substance abuse on campus and the perceived roles of health-care providers and patients in screening and conducting interventions for substance abuse. These findings suggest that training for college health-care providers regarding substance-abuse brief screening and intervention should emphasize confidentiality of student medical records, the importance of nonjudgmental attitudes toward students, and the role of the provider as one who is competent and appropriate to address substance abuse. Such training should also educate providers about the types of substances students are using.