Implementing Single Session Therapy

In recent decades, discussion about clinical practice has been dominated by a focus on evidence‐based treatments, whilst the translation of evidence‐based treatments into practice has been neglected or avoided. The single session therapy (SST) field reflects this general trend. As a result, the community has not benefited from available service improvements simply because they have not found their way into core practice or been translated across state‐wide services. This article draws on a range of implementation projects managed by The Bouverie Centre, in particular a successful state‐wide SST implementation project conducted in collaboration with Victorian community health counselling services, to raise implementation dilemmas and suggest practical ideas about the translation of SST ideas into mainstream clinical practice. It is hoped this discussion will be of interest to those wanting to translate any new idea into practice.     

Reflections and Learning From an Agency‐Wide Implementation of Single Session Work in Family Therapy

In November 2009, the Bouverie Centre, a centre for training, research, and clinical family therapy in Melbourne, Australia, embarked on a 12‐month trial involving the implementation of single session work as our main model of service provision for all new family appointments. We were interested in evaluating clients' and therapists' experiences of this change in our clinical service delivery. This article discusses some clinical dilemmas that arose for staff in this process, and how they were addressed. Clients' responses to single session work are outlined, followed by a discussion of outcomes of the implementation for our organisation.     

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.     

Family Therapy in Child and Adolescent Mental Health Practice: Integrating Family Therapy in Child and Adolescent Mental Health Practice: An Ethic of Hospitality

This article integrates family therapy in contemporary child and adolescent mental health services as an evidence‐based practice. An integrative practice model is proposed where contextual approaches like systemic and narrative therapy complement and enrich individual problem‐focused models such as biological psychiatry and cognitive therapy. This is based on an ethic of hospitality towards all therapy discourses and the following best practice guideline: ‘To make optimum space for a systemic and narrative understanding contributes to evidence‐based practice in a contemporary mental health service.’ After discussing some dilemmas of integrative practice, I illustrate the therapeutic process by a detailed example of integrative family therapy with a depressed suicidal adolescent.     

Dialogical Research in Supervision: Practical Guidelines from Experienced Supervisors in Family Therapy,Child Protection,and Specialty Mental Health Services

This two‐year qualitative participatory research project examines practical guidelines for supervision. Sixteen experienced supervisors across professional settings of family therapy, child protection, and specialty mental health services in the geographical regions of Northern Norway and Northern Sweden outline four main practical guidelines in supervision based on their supervisory practices: (1) elaborating an agreed‐upon contract; (2) exploring potential formats; (3) exploring contents; (4) acknowledging responsibility for process and dilemmas. Participants summarised how they generated mutual growth in supervisory relationships, while being respectful of the first‐person perspective of supervisees. The study challenges pre‐dominating guidelines about deficit‐ or developmental stage‐oriented supervision. It illustrates reflecting processes and a polyphonic orientation in supervision by welcoming diversity, wondering, and tolerance for the not‐yet‐decided among involved persons in a mutual exploration and calibration of relevant knowledge. It outlines a dialogical research for sharing, exploring, and questioning knowledge as beneficial for whom, told by whom, and evaluated by whom.     

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.     

Engaging with Parents in Child and Adolescent Mental Health Services

This paper asks the question: How can child and adolescent mental health clinicians constructively engage parents as a resource in the young person's treatment? It draws from qualitative research data that explore parents' experience of their involvement in their adolescent's mental health treatment program. The paper especially focuses on challenges for clinicians in engaging with parents as part of the treatment program for young people. Clinicians' input about their perceptions of interacting with parents is utilised alongside parents' experiences of their involvement in clinical processes. The clinician data revealed key challenges were managing their reactions to parent defensiveness; broadening the focus from just alleviating symptoms in the young person; not taking sides with the young person; and resisting becoming an expert instructor. The paper discusses Murray Bowen's original family research about engaging parents in treatment with the symptom bearer and addresses how clinicians can build a positive alliance with parents that avoids blame while constructively opening exploration of the family relationship process as part of a collaborative approach.     

A Child‐inclusive Family Intervention in a Community Adult Mental Health Service

In this paper we describe an intervention that focuses on the needs of children in families where a parent has a mental illness and attends a community adult mental health setting. After a brief outline of the literature, we present a family approach that includes children and young people, their parents and grandparents. Case studies then illustrate the work as a ‘best practice’ for parents who are clients in community adult mental health services.     

Integrative Family Therapy for Child Behavioural Problems in a Parenting Support Agency

This paper describes family therapy for behavioural problems in a parenting support agency. It discusses the literature on the effectiveness of family therapy with child behaviour problems within a community support environment. The paper presents a detailed family case study, which is discussed from an integrative family therapy framework. Narrative therapy is used as an overarching framework for integrating systemic therapy and parenting skills to help a family with a mixed cultural Aboriginal and Australian background. This allows sessions that are meaningful for the family and encourages a connection to their own resources and to their community, besides creating a safe space for a dialogue that hears and values all voices.     

Divorce and Family Structure in Norway: Associations With Adolescent Mental Health

The aim of this study was to examine the association between family structure and adolecent mental health, after the considerable increase in divorced parents choosing joint physical custody (JPC) in Norway. Data stem from the youth@hordaland study, a population-based survey conducted in Norway in 2012. A total of 7,707 adolescents (47% male) 16 to 19 years old were included in this study. The adolescents were classified into 6 family structures. Mental health was measured using the Strengths and Difficulties Questionnaire (SDQ). No significant differences between nondivorced families (reference) and JPC were observed. Adolescents from single-parent and stepfather families scored significantly higher on all 3 SDQ scales, and adolescents from stepmother families scored significantly higher on the SDQ total and SDQ externalizing scales. In conclusion, the results of this study indicated that adolescents living in JPC did not have more adjustment problems compared to their peers living in nondivorced families.     

Back to the Future of Social Work: Child and Adolescent Mental Health and the Post Qualifying Curriculum in England and Wales

The first social work course to focus on children's mental health in the UK began in 1929 at the London School of Economics and Political Science. The subsequent child guidance movement spawned the genesis of child and adolescent mental health services (CAMHS) where social workers held a pivotal and much-respected role among multi-disciplinary teams. This role has been undermined in recent years. Post qualifying social work education and training needs to recognise and reflect the potential social work contribution to modern CAMH services to enable social workers in England and Wales to engage and contribute to supporting the increasing numbers of troubled young people. This paper sets out a rationale, knowledge base and outline content for ways in which the post qualifying social work curriculum can be developed to equip social workers with the necessary skills to engage purposively in this area.     

The Relationship between Change and Satisfaction: Parents' Experiences in a Child and Adolescent Mental Health Service

In the consumer satisfaction literature, there is little exploration of the relationship between change and satisfaction and the two are often conflated. This qualitative study interviewed parents a year after using child and adolescent mental health services. Eliciting an account of their experiences enabled the development of ‘grounded theories’ about what constitutes satisfaction for parents. The outcomes suggest that in addition to the expectable stories of ‘high change and satisfaction’ or ‘no change and low satisfaction’, considerable numbers of people are satisfied with a service despite experiencing little or no change, while others who experience positive change are not satisfied. Understanding these alternative stories helps address critical issues that affect the way therapists respond to people's needs and provide services — these matters are often within the capacity of therapists and services to address, even when working with limited resources.     

Cognitive-Behavioral Family Therapy with a Family in High-Conflict Divorce: A Case Study

Children who live in families with high-conflict divorce situations are increasingly coming to the attention of clinicians. This paper explains the nature of the impasse of high-conflict divorce. It presents a brief theoretical overview of cognitive-behavioral family therapy as an effective approach to treatment for high-conflict divorce families. A case study that successfully utilized a cognitive-behavioral approach to family therapy is presented. Specific techniques such as parent training, communication and empathy skills, problem-solving skills, assertiveness training, role-modeling on the part of the therapist and application of the concept of reciprocal inhibition were included in the cognitive-behavioral family treatment. An N=1 research design is graphically illustrated for evaluation purposes.     

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.     

Family Phone Therapy in University Counseling and Psychological Service Centers: A Family Systems Approach

Abstract

This paper offers family phone therapy as a method for student mental health practitioners to overcome the obstacle of geographic distance between students and their families when family therapy is the treatment of choice. The issues of confidentiality, triangulation, diversionary conversation, and mixed communication, which present unique concerns when engaging in family phone therapy, are introduced and strategies to deal with them are discussed. A case example is presented to demonstrate the utility of family phone therapy in dealing with problems that students who use university mental health services can typically experience. Finally, implications of dealing with students' developmental tasks from an individual or family systems perspective are discussed.     

Work,Family, and Mental Health: Testing Different Models of Work‐Family Fit

Using family resilience theory, this study examined the effects of work‐family conflict and work‐family facilitation on mental health among working adults to gain a better understanding of work‐family fit. Data from the National Survey of Midlife Development in the United States (MIDUS) were used to compare different combinations of work‐family conflict and work‐family facilitation. Results suggest that family to work facilitation is a family protective factor that offsets and buffers the deleterious effects of work‐family conflict on mental health. The results across these outcomes suggest that work‐family conflict and facilitation must be considered separately, and that adult mental health is optimized when family to work facilitation is high and family to work and work to family conflict is low.     

Specific Cases,Techniques and Approaches: Talking Pictures in Family Therapy

This article presents a case study on the use of arts‐based resources in family therapy to help children and their post‐separation families describe their experience, communicate and collaborate with each other, witness and learn about each other, and develop their individual and family well‐being.