Integrating Solution-Focused Brief Therapy for Systemic Posttraumatic Stress Prevention in Paediatrics

Paediatric trauma can leave devastating effects on patients and their families if unattended. Medical family therapy (MedFT) is one approach to address the emotional and relational impact of paediatric trauma and prevent possible posttraumatic stress. The biopsychosocial model is widely practiced in MedFT, yet we argue that adding solution-focused conversations can further enhance practitioner effectiveness and increase client outcome. This article discusses and provides rationale for the use of solution-focused brief therapy (SFBT) through a biopsychosocial lens when treating paediatric intensive care unit (PICU) patients and their families. A fictionalised illustration is provided to guide family therapists in applying SFBT to the PICU population.     

Family Social Work Practice: Onward to Therapy and Policy

ABSTRACT

In a recent article published in the Journal of Family Social Work McNeece (1995) argued that family therapy has no interest in or relevance for social policy interventions. Through the presentation of several arguments he constructs an irreconcilable dichotomy between policy and practice, suggesting that therapeutic interventions are responsible for pulling resources away from the development of effective social policy interventions. This paper challenges the dichotomy between policy and practice and presents an alternative view concerning the relationship between social policy and family therapy. The increasing importance of family policy in family therapy is summarized and a new trend within marriage and family practice, policy as practice, is discussed. Current family practice literature and personal case examples are used to provide alternative viewpoints to three main points that were presented by McNeece concerning family therapy practice, and the therapy/policy interface. Finally, the current practice context of managed care is used to illustrate the interdependence of practice and policy, and the need for a new understanding concerning family practice.     

Introducing Evidence‐Based Family Assessment and Therapy in Child and Youth Mental Health Services: Applying Systemic Principles to Maintain,Sustain and Build Capacity

The purpose of this article is to overview the context of the mental health service in which we work, and family therapy's status prior to and after the impact of changes wrought by the introduction of the National Mental Health Policy. We then explore some key issues that we think contribute to the persistence of the occlusion of family therapy in child psychiatric services; and the strategies that we developed and are continuing to develop to support change. Finally, we describe the use of a family assessment instrument that we believe is central to our change strategy.     

Marriage and Family Therapy Trainees' Reports of Explicit Weight Bias

Discrimination based on an individual's weight has been observed in health care, education, retail, and other public sectors (Puhl & Huer, Obesity, 17, 941, 2007). Such inequity, known as “weight bias,” generates negative short‐term and long‐term consequences for the individuals that experience it (Puhl & Brownell, Weight bias in health care settings, 2007). Past research has shown that healthcare trainees exhibit weight bias (Phelan et al., Obesity, 22, 1201, 2014; Wigton & McGaghie, Journal of General Internal Medicine, 16, 262, 2001), yet little focus is given to weight bias in marriage and family therapy (MFT) education. The purpose of this study was to survey MFT students (N = 162) to explore weight bias and how contextual factors associate with weight bias. Participants in MFT programs reported explicit weight bias, with specific contextual factors associating with more bias. Female participants reported more fear of gaining weight, and individuals who identified as overweight had higher rates of explicit weight bias. Contextual differences and implications for training programs are discussed.     

Groupwork for Parents whose Children are in Care: Challenges and Opportunities

Until recently, the focus for child protection in NSW has been on risk assessment, supportive measures for parents, and ‘the best interests of the child’. The needs of the birth families, once their children have been removed have not received the same attention. An emerging body of research indicates a growing awareness of the importance of the link between good outcomes for children in care and positive ongoing links with their birth parents. Biological parents of children who have been removed invariably continue to have parenting relationships, if not with the removed child, then with subsequent birth children, step children and children in their extended family. Service provision for this group of parents is critical given the complexity and scale of their emotional needs, and the implications for the children they will care for. In this paper, we describe one such intervention: Kids in Care, a group program offered at Relationships Australia NSW, and consider the arising issues and dilemmas for both parents and group workers. Developed to address the particular needs of parents whose children have been taken into care, the group creates an environment of acceptance and support. This opens up possibilities for parents to consider issues of grief, stigma and trauma, as well as to develop skills in communication, assertiveness and emotional regulation.     

Exploring Epistemologies: The Debate Continues

ABSTRACT

Stigma is a significant barrier to recovery and full community inclusion for people with mental illnesses. Social work educators can play critical roles in addressing this stigma, yet little is known about their attitudes. Social work educators were surveyed about their general attitudes about people with mental illnesses, attitudes about practice with people with mental illnesses, and attitudes about students with mental illnesses. On average, educators’ general and practice attitudes were not negative. However, respondents did view a student with a mental illness differently from a “typical social work student.” Findings suggest that we, as social work educators, must raise our awareness and address our own attitudes to support students and uphold our social work values.     

Global Convergence: Aging and Long-Term Care Policy Challenges in the Developing World

Aging around the world poses a global challenge in eldercare. This challenge is particularly felt in low- and middle-income countries (LMICs), where population aging outpaces the development of aged care policies and services. This Perspective highlights the phenomenon of global convergence in several unsettling trends and challenges shared across LMICs. These include the weakening of informal family care systems for the elderly, growing need for formal long-term care of the frail and disabled who can no longer be adequately supported by family members, and mounting pressures for policy responses to tackle these societal challenges. It is argued that policymakers should take a proactive stance. That is, when family care for the elderly falls short and family caregivers are increasingly under strain, the government should step in and step up support to fill in the gap by developing appropriate policies and a continuum of long-term care services that are accessible and affordable for the majority of older people in need. Three general principles are then suggested with regard to long-term care provision, financing, and quality assurance, which transcend national borders and can be used to guide long-term care policymaking across LMICs.     

Family Microtransitions: An Observational Study

This research aimed to study the processes that take place during family microtransitions, that is, when family members move from an interactive form characterized by specific roles (active or peripheral) to another form that requires a change in these roles. For this purpose, 21 normative triads composed of mother, father, and a 4-year-old child were observed in a laboratory while playing together in a setting where they were asked to change their interactive configuration three times. The data revealed different ways of family functioning in coping with the microtransitions. Two groups emerged from the analysis that presented different characteristics. In particular, the family triads that completed the assigned task showed a significantly higher level of coordination and emotional tuning, a larger number of processes implied in the triadic dynamics, and a greater communicative coherence between the verbal, the expressive, and the corporal channels, compared with the group that did not complete the task.     

Abstracts

Benedek, E. P. & Benedek, R. S. Joint custody: Solution or illusion?American Journal of Psychiatry, Bennett, M. J. & Wisneski, M. J. Continuous psychotherapy within an HMO. American Journal of Psychiatry, DiBella, A. W. Family psychotherapy with the homosexual family: A community psychiatry approach to homosexuality. Community Mental Health Journal, Green R. J., Ferguson, L. R. Framo, J. L. Shapiro, R. J. & La Perriere, K. A symposium on family training for psychologists. Professional Psychology, Ferguson, L. R. The family life cycle: Orientation for interdisciplinary training. Professional Psychology, Framo, J. L. A personal viewpoint on training in marital and family therapy. Professional Psychology, Shapiro, R. J. The problematic position of family therapy in professional training. Professional Psychology, La Perriere, K. Toward the training of broad-range family therapists. Professional Psychology, Mirande, A. A reinterpretation of male dominance in the Chicano family. The Family Coordinator, Murray, M. E. Family character analysis. American Journal of Psychoanalysis,     

Deactivating the Buttons: Integrating Radical Exposure Tapping with a Family Therapy Framework

The purpose of this paper is to describe and illustrate with case examples a brief intervention termed Radical Exposure Tapping (RET). RET can be integrated with family therapy to address stuck points where the therapy is hindered by a family member's affective block, an intense and unchangeable emotional reactivity to a specific trigger. RET draws from the methodology of Eye Movement Desensitization and Reprocessing (EMDR) and combines it with the tapping sequence of the Emotional Freedom Technique (EFT) to produce an intervention that is more flexible than EMDR, provides greater rigor than using the EFT technique alone and can be effective in a single session within the context of family therapy. The paper puts this work into context by first over viewing definitions of trauma and Post‐Traumatic Stress Disorder, arguing that family members' emotional reactivity may be a symptom of PTSD even when they would not qualify for the diagnosis because they had not experienced a life threatening event.     

Ten Research Questions for Family Therapy

A growing evidence‐base shows that family therapy works, but many gaps in our knowledge remain about the conditions under which family therapy is effective and how it works. In this paper, ten critical research questions about family therapy that need to be addressed are considered. In short these are:

• 1 Is family therapy as effective in community settings as it is in specialist clinics?
• 2 For what problems is family therapy cost‐effective?
• 3 Does family therapy work for under‐researched problems and populations?
• 4 Do social‐constructionist and narrative approaches to family therapy work?
• 5 Can family therapy protocols be enhanced for non‐responders?
• 6 Can family therapy be combined with other psychotherapies to effectively treat specific problems?
• 7 Can family therapy be combined with pharmacotherapy to effectively treat specific problems?
• 8 What specific factors contribute to the effectiveness of family therapy with particular problems?
• 9 What common factors contribute to the effectiveness of family therapy?
• 10 What therapist and client factors contribute to the effectiveness of family therapy?

     

Substitution and Presence Effects of Children on Mothers’ Adult Care Time

This article analyzes the effects of the presence of children on the time devoted to adult care. Using the 2002 Spanish Time Use Survey (STUS), we examine two possible effects of children: (i) a negative effect, the Substitution Effect, associated with active childcare, and (ii) a positive effect, the Presence Effect, associated with passive childcare. Our results show that both effects have significant impacts on the ways in which mothers devote time to adult care activities. We find that an additional child in the family, under age 18, reduces the probability of caregiving, the Substitution Effect, while the presence of children during adult care, the Presence Effect, increases the probability of caregiving.     

Meeting the Challenge of Preparing Social Workers for Integrated Health Practice: Evidence From Two MSW Cohorts

ABSTRACT

Changes in health care policy have led to an expansion of integrated care models that rely on collaboration among interprofessional health teams. Recent federal funding has encouraged the development of innovative training models to prepare social workers for integrated health practice. This article presents evidence from the first two MSW cohorts of the Integrated Mental and Behavioral Health Training Program funded by the Health Resources and Services Administration. Twelve students completing the program in 2014 (n = 5) and 2015 (n = 7) participated in evaluation activities at the time of program completion and at 1-year postgraduation. Findings highlight key components of the training program instrumental in student attainment of program goals and competencies. Implications for MSW education and training for practice in integrated care environments are discussed.     

Brief Behavioral Interventions for Symptoms of Depression and Insomnia in University Primary Care

Abstract

Objective: To describe how behavioral activation (BA) for depression and stimulus control (SC) for insomnia can be modified to a brief format for use in a university primary care setting, and to evaluate preliminarily their effectiveness in reducing symptoms of depression and insomnia, respectively, using data collected in routine clinical care. Participants/Methods: Chart review data were obtained for 11 patients treated between August 2009 and December 2010 with 1 session of brief BA for depression and 17 patients treated with 1 session of brief SC for insomnia. Results: At 2-week follow-up, patients reported significant decreases in symptoms of depression on the Patient Health Questionnaire-9, t(10) = 3.95, p < .05, and insomnia on the Insomnia Severity Index, t(16) = 5.43, p < .05, respectively. Conclusions: This case report provides preliminary evidence of the external validity of brief BA and SC after they were adapted for use within university primary care.     

ON THE VALUE OF INTEGRATING APPROACHES TO FAMILY THERAPY

This paper considers the strengths and weaknesses of an integrative approach to family therapy. An integrative approach can explain a broad range of human behavior, can shape intervention strategy in a manner appropriate to each case, can allow for treatment of a broad client population, can combine the strengths of each of the specific approaches, can promote objectivity in selection of strategies of change, and can permit easy expansion of the repertoire of techniques. The potential pitfalls basically revolve around the complexity of practice; in particular, the possibility of inconsistency of approach. With care, these pitfalls can be avoided. Integration is viewed as a viable alternative to school-specific practice in family therapy.     

Patients' Evaluations of the Mental Health Service at a Health Sciences Campus

Abstract

Health science students, along with the health professionals they hope to become, are at increased risk for certain occupational injuries and illnesses. One of these risks is occupational exposure to blood-borne pathogens, such as human immunodeficiency virus (HIV) and hepatitis, which may result in severe illnesses or even death. Two case studies demonstrate postexposure care of exposed individuals at the University of Texas Medical Branch Student Health Services before and after policy changes and prevention strategies were strengthened in response to exposure incidents.     

‘Let's Live,and See’: Interview with Moshe Talmon

Moshe Talmon, author of Single Session Therapy and Single Session Solutions, spoke to Lil Cox, family therapist from Oakrise Child & Adolescent Mental Health Service at Launceston, when she caught up with him at the Inaugural Pan‐Pacific Family Therapy Conference in Melbourne, Australia in September 2001. He spoke about his early life, training, his research showing that clients can get what they need from one session, and his current approach to therapy. Finally, he gives his reasons for continuing to live and work in Israel.     

Family Sculpting: A Pilot Program for a Schizophrenic Group*

Verbal group therapy is a conventional treatment for schizophrenic patients. This report describes a pilot program of brief group therapy which utilized nonverbal sculpting techniques as the central therapeutic modality. Family sculpting provided a structured format for the patients to organize perceptions of self and family within specific contexts, to experience these perceptions in action, and employ them in resolving family conflicts.