THE EFFECTIVENESS OF PSYCHOEDUCATIONAL FAMILY THERAPY IN THE TREATMENT OF SCHIZOPHRENIC DISORDERS

A review of the literature on family psychoeducational interventions in schizophrenic disorders revealed two generations of studies. The first generation compared the clinical efficacy of psychoeducational family treatments and medication to medication only or routine care. A second generation of studies used more complex experimental designs that often narrowed the differences between the experimental treatment and comparison conditions. The results of the first generation of studies are unequivocal in demonstrating the superiority of family intervention plus medication over medication alone in delaying psychotic relapses. The second-generation studies had more equivocal results; they suggest that the efficacy of family intervention as an adjunct to medication in schizophrenia is in part a function of the type and format of the intervention being delivered, the treatment setting, and other variables.     

STAGES OF FAMILY INVOLVEMENT IN THE RESIDENTIAL TREATMENT OF ADOLESCENTS

A strong case has been made in the literature that the effective treatment of adolescents in long-term psychiatric hospitals or residential treatment centers must include treatment of the family. This highlights the need for a family treatment model that integrates a long-term psychodynamically oriented residential treatment approach with family systems theory. Such a model must take into account the stages of inpatient treatment and must address therapeutic management of the physical, emotional and psychological aspects of separation between the adolescent and the family. A bridge between family systems theory and psychoanalytic theory can be found in object relations theory. A four-stage model for working with families having a hospitalized adolescent member is described in which each stage builds upon the previous one. Progress through the stages depends upon the establishment of a relationship in which the family perceives the hospital as supportive, nonjudgmental, helpful and trustworthy.     

THE EFFECTIVENESS OF FAMILY INTERVENTIONS IN THE TREATMENT OF PHYSICAL ILLNESS

Although a large body of research demonstrates that the family has a powerful influence on physical health, the evidence for the effectiveness of family interventions in physical illness is less conclusive. Family therapy and other family interventions appear to be most effective in chronic childhood illnesses such as asthma and diabetes. Family interventions have also been shown to be effective in the management of some cardiovascular and neurologic disorders and for the treatment of obesity. Family therapy appears to be more effective than individual therapy for some groups of patients with anorexia nervosa. This research supports the increasingly important role of medical family therapy in the new health care system. Recommendations for future research are discussed.     

NURTURANCE: A NEGLECTED DIMENSION IN FAMILY THERAPY WITH ADOLESCENTS*

This paper offers a model for integrating a nurturance framework into family therapy approaches with adolescents. This approach is seen as adding an important but neglected dimension to commonly used approaches, thus increasing both flexibility in treatment and the likelihood of a positive outcome. Steps to an effective treatment approach are outlined and guidelines offered for both in-session work and out-of-session tasks.     

THE EFFECTIVENESS OF FAMILY THERAPIES FOR SELECTED BEHAVIORAL DISORDERS OF CHILDHOOD

This article reviews the scientific evidence for the effectiveness of family-based aproaches in the treatment of selected childhood behavioral disorders. Although limitations certainly exist, family interventions have consitently improved child and, in some cases, parent functioning in families with children presenting with conduct disorder (CD) and autism. Parents and other family members also directly benefit from child-focused interventions, gaining in knowledge, child management skills, and attitudinal improvements. Longh-term follow-ups indicate that CD and autistic children achieved lasting gains. Similarly, the research on attention-deficit/hyperactivity disorder (ADHD) indicates that parent training improves child noncompliance and aggression yet does not consistently affect core symptoms of ADHD. There is no evidence that adding short-term family interventions improves ADHD child functioning beyond improvements from the use of psychostimulant medications. Some tentative support for family involvement in the treatment of childhood anxieties and fears is reviewed, but clear conclusions await future investigations. Finally, several methodological limitations and needed areas of research are discussed.     

THE EFFICACY AND EFFECTIVENESS OF MARITAL AND FAMILY THERAPY: A PERSPECTIVE FROM META-ANALYSIS

This article reviews the major findings from a multiproject meta-analysis of the effects of marital and family therapy (MFT). Across 163 randomized trials, MFT demonstrates moderate, statistically significant, and often clinically significant effects. No orientation is yet demonstrably superior to any other, nor is MFT superior to individual therapy. Cost effectiveness information is scant in these 163 studies, but supportive. Randomized experiments yield very different answers from nonrandomized experimental studies of the effects of MFT, calling into question whether we should mix the two in reviews. We have also found several new differences in the ways that marital therapy (MT) and family therapy (FT) studies are conducted, making them harder to compare. Finally, important questions still exist about whether any psychotherapy, including MFT, yet has sufficient information about how well research generalizes to everyday clinical practice.     

COST EFFECTIVENESS RESEARCH IN FAMILY THERAPY*

The authors attempt to demystify the process of conducting cost effectiveness research by defining relevant terms and decribing the necessary steps. Two provious cost-effectiveness studies of family based treatment are briefly described to illustrate cost-analysis procedures that may be used in future family therapy research.     

THE POLITICS OF GENDER IN FAMILY THERAPY

This article provides an overview of the political implications of various approaches to gender within the clinical literature. It emphasizes the process of the rapy within the social context of gender relations and identifies the politcal consequences of various clinical responses. Issues surrounding the appropriate role and stance of therapists relative to gender are identified, ethical issues such as neutrality and client welfare are re-examined, and suggestions for practice are addressed.     

THE CORRELATES OF HEALTHY FAMILY FUNCTIONING: THE ROLE OF CONSENSUS AND CONFLICT IN THE PRACTICE OF FAMILY THERAPY

The present study explores the relative importance of individual, dyadic and triadic measures of intrafamily functioning in predicting family health. Using self-report data from 78 families, it was found that dyadic measures pertaining to marital quality and parent-child relationships were more powerful predictors than either individual measures of emotional maturity, anxiety, self-esteem or locus of control, or triadic measures of the families' hierarchical alignments. The study also found that while mothers' and fathers' assessments of intrafamily functioning were more important than the childrens' (except for the childrens' view of parent-child relationships), the parents differed in that marital quality was more important to the mothers' evaluations of the family unit while parent-child relationships were more important to the fathers'. Compositely, the findings suggest that family health is a complex multidimensional phenomenon, and that change in a particular dimension of family life may not necessarily be greeted with consensual validation or repudiation by all family members.     

TRAINING THE PERSON OF THE THERAPIST IN STRUCTURAL FAMILY THERAPY

Structural Family Therapy needs a training model that integrates the existential, human mutuality of the therapeutic relationship with its technical elements. This paper offers a theoretical foundation for training structural family therapists in the use of self, discusses a model for training, and gives a case example illustrating personal training in a clinical context.     

USE OF FAMILY IN THE TREATMENT OF SCHIZOPHRENIC AND PSYCHOPATHIC PATIENTS*

Editor's Note. Occasionally, the Journal of Marital and Family Therapy will publish papers of major historical significance to the field of family therapy which, though written long before their appearance in the Journal, have remained unpublished and received little public circulation or attention. Such papers are those which, in the view of the Editor, would have been certain “classics” in the literature of family therapy had they been published when they were written, and which, despite their overdue appearance, are of significant enduring value. The first of these papers, by Dr. C. F Midelfort, appears here. Though essentially isolated from the family therapy movement that was soon to follow, Dr. Midelfort, in fact, published the first book on family therapy. The present article grows out of what was probably the first paper on family therapy ever presented at a psychiatric convention in the United States. In this paper, originally written almost exactly thirty years ago, Dr. Midelfort articulately presents a creative interweaving of an appreciation of the psychodynamics of family relationships with an ego-oriented family approach to severe psychiatric disturbance in one family member. It is an innovative presage of the flexible use of the principles of family dynamics, social psychiatry and biological psychiatry that has been “discovered” only very recently in family therapy with schizophrenics. The paper is introduced by Dr. John E. Bell, to whom the Journal is grateful for bringing it to light.     

EMPIRICAL VALUES AND THE CULTURE OF FAMILY THERAPY*

The research-clinical practice connection is weak in family therapy. Some have argued, in an inordinate ideological and political tone, that traditional research methods are inappropriate for family therapy. This position mischaracterizes modern day clinical researchers and research. In presenting 10 key dimensions of the research-clinical practice issue in family therapy, this paper addresses some of these misrepresentations. If research and practice are to interact more productively, a major commitment, the scope and implications of which have not yet been realized, will need to be made. Actualizing the research-practice link is a training problem and a fundamental professional issue. Progress in this realm would change the particulars of clinical practice as we know it. These processes will involve nothing less than remaking the culture of family therapy.     

USING THE TELEPHONE IN FAMILY THERAPY

This article explores use of the telephone as a communication medium for engaging families in the therapy process. A review of related literature is followed by an exploration of some of the challenges involves. The author offers suggestions for conducting phone sessions, provides a case example, examines some of the ethical issues involves, and ponders the possible future impact of advanced telephone-related communication technology on family therapy.     

USE OF THE DSM IN MARRIAGE AND FAMILY THERAPY PROGRAMS: CURRENT PRACTICES AND ATTITUDES

The DSM has largely become the common language of behavioral health which its authors intended. Although family systems theory resulted in part from the study of major mental illness, it later became distanced from considerations of individual psychopathology. No studies have assessed current practices and views within the field of family therapy on teaching students the use of the DSM. Member training programs of the Education and Training Council of the American Association for Marriage and Family Therapy were surveyed regarding their practices in teaching the DSM. Seventy-nine of 177 surveys (45%) were returned. Ninety-one percent of these programs offered training in the DSM, and in 93% of those such training was mandatory. Written comments indicated that pragmatic concerns about students being able to speak a common language with other behavioral health providers were among the primary reasons for teaching the DSM.     

FAMILY THERAPY WITH INTELLECTUALLY AND CREATIVELY GIFTED CHILDREN

Few family therapists have expertise in the psychology of giftedness, and little research has been conducted to determine the effectiveness of family therapy with talented children and their families. The purposes of this paper are: (1) to provide family therapists with information on the unique psychosocial stressors associated with giftedness and (2) to stimulate further research and development on the efficacy of family therapy in alleviating distress and actualizing potential in gifted and talented children and their families. The paper provides a critical overview of the existing research literature on gifted children and their families. First, current conceptualizations of giftedness are described. Then the research literature on the characteristics of intellectually and creatively gifted children and their families is reviewed with an emphasis on the endogenous (individual) and exogenous (systemic) factors that can create or exacerbate psychosocial problems. Finally, we suggest an eclectic, eco-systemic approach to three common concerns that bring gifted children and their families to therapy.     

THE SAIGON OF THE FAMILY'S MIND: FAMILY THERAPY WITH FAMILIES OF VIETNAM VETERANS

Unlike other wars, Vietnam was America's first teenage war. This has caused unique problems in dealing with the Vietnam veteran, as exemplified by the Post-Traumatic Stress Disorder (PTSD). Although the bulk of the work done on PTSD has indicated the likelihood of veterans establishing disengaged families, it has been the author's experience that the families of Vietnam veterans often have enmeshed parent-child ties between the veteran and his children. When the children become adolescents, their quest for individualization throws the family into turmoil which has its genesis in the father's own foreclosed identity. A five-stage method of treatment (Intake, Ventilation, Bridging, Education and Hiking the Therapy Home) is proposed by the author as being a sound method of family treatment in this growing family problem.     

THE CLINICAL AND THEORETICAL IMPACT OF A CONTROLLED TRIAL OF FAMILY THERAPY IN ANOREXIA NERVOSA

The paper discusses the practical and theoretical implications of the results of a controlled treatment trial. Family therapy was compared with individual, supportive psychotherapy for the management of severe eating disorder. Family therapy was markedly more effective in achieving improvement in one of four subgroups of patients: (a): those with early onset, short duration; (b) early onset, duration more than 3 years; (c) late onset, after the age of 18 years; (d) those with bulimia nervosa. The therapies used are described, as are the changes in clinical practice arising from the study. Theoretical considerations concerning notions of family structure, the family life-cycle and symptomatic and family change are also discussed.