Schizophrenia and Family Therapy

The case presented is of a young man hospitalized twice for schizophrenic disorder before the commencement of family therapy. The therapy which dealt with the family system, specific pathological communication patterns and intra-psychic conflicts, is discussed. As the parents of the young man confronted their inter- and intra-personal problems, the function of his illness disappeared, along with his psychotic symptoms. While demonstrating the process of psychotherapy, the thesis that psychotic decompensation in young people often signifies severe family dysfunction is also presented. Accepting the ‘identified’ patient as such and ignoring the family dynamics may serve to create a chronic schizophrenic illness.     

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.     

The fear of understanding schizophrenia and the avoidance of the acutely disturbed student

Although it is generally believed that a treatment that is more effective than its alternatives will be used, psychological treatments for schizophrenic and other psychotic reactions have been avoided despite the evidence of their effectiveness from the time of "moral treatment" to the present. Less effective (or even destructive) treatments have been seized upon, in part because they do not require understanding patients. Understanding them means facing facts about ourselves, our families, and our society that we do not want to know, or, in the case of repressed feelings and experiences, do not want to know again. This reluctance to understand is particularly tragic in the case of the acutely disturbed college student, whose crisis may lead either to reorganization at a higher level of functioning and growth or to a wasted life. The central role of terror in producing symptoms and the genesis and handling of symptoms, including delusions and hallucinations, are briefly discussed.     

Survival dilemmas: Case study of an adult child of a schizophrenic parent

This article describes aspects of the treatment of an adult child of a schizophrenic parent. Many theories on irrationality in the family setting illuminate the range of impingement on the child's reality when a parent is disturbed in this way. Current research has absorbed itself in interpretations of data on risk, vulnerability, disorder, and early trauma, which have implications for prevention as well as therapeutic treatment of the adult survivor. Profound effects on Ms. P's early development are elaborated in the therapy, in which the treatment stance is influenced by Kohut's theories of the self, particularly as applied to the establishment within the holding environment of specific transferences that facilitate reconstructive work.     

Separation and Post‐Separation Parenting within Lesbian and Gay Co‐parenting (Guild Parented) Families

Gay men and lesbian women have a long history of jointly creating families and co‐parenting their children together. This qualitative study aims to explore the experiences of separation and post‐separation parenting within same‐sex parented families. This involved semi‐structured in‐depth interviews with 22 separated same‐sex parents in Adelaide, Melbourne, Sydney, Brisbane, and regional Victoria. An adaptive theory approach was used for the collection and analysis of the data. The paper explores data from a cohort of six participants who came from three different multi‐parent families who had experienced a separation – either their own, or that of other parents in their parenting group. The term ‘co‐parenting families’ was found to be confusing due to the different connotations within separation/divorce and same‐sex parent literature. Consequently, the term ‘guild parented families’ was created to describe these families. Participants from these multi‐parent families had very different experiences of family formation and separation compared to others within the wider separated same‐sex parent study. Separation of one or more of the parent couples within these families complicated their original plans and kinship ideals. Each of the families resolved this differently in their post‐separation arrangements. After separation, whole family narratives and/or the role of individual parents, were either questioned or revised as a way of resolving the complexity of their new kinship situation. Following separation, parents often relied on Western kinship norms that privilege biological kinship and the dual‐parent family to construct their post‐separation kinship arrangements. More awareness of families that begin with more than two parents is needed within separation research and amongst separation services and service providers.     

‘Putting Humpty Together Again’: Working With Parents to Help Children Who Have Experienced Early Trauma

Early interpersonal trauma can have a profound impact on young children's emotional, cognitive and physical function, and on their ongoing development. This article outlines the diverse effects of trauma and how they might present in school or childcare settings. It considers the role of the family in the development of children's emotion regulation, especially if trauma occurs in the context of the family and how trauma affects family dynamics. A therapeutic approach is then outlined to help address the multiple areas of difficulty. Work with parents and the whole family is aimed at maintaining physical and emotional safety and building trust between parent and child. Work with the parents, teachers and the child individually is directed at helping the child develop emotion regulation and competence physically, cognitively and interpersonally.     

The effect of long-term outcome studies on the therapy of schizophrenia

According to long-term follow-up studies of people diagnosed schizophrenic, one half to two thirds will become normal and be back in the community after a period of years. With evidence that schizophrenia is reversible, professions involved in social control and those doing therapy face new responsibilities. Therapists can approach psychotic symptoms expecting the person to become normal. The goal is to help people past periods of acute disturbance without doing them long-term harm.     

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.     

The Family Movement,Bowen Theory,and Theoretical Medicine: A View from the 21st Century

Important changes have occurred in the family movement in the United States since it emerged in the mid‐1950s. Psychiatry supported the movement in its early years, but that changed as psychiatry abandoned the biopsychosocial model and adopted the biological paradigm through the 1970s. This development pushed family and other therapies to the periphery of the discipline. Medicine is dominated by the biological paradigm and cause‐and‐effect thinking. The roots of the medical model go back to Pasteur. In contrast, psychiatry in the United States had been dominated through the 20^th century by psychoanalytic thinking, which rendered the discipline a step‐child to medicine. This and other factors pushed psychiatry to get biological. The change generated a ‘failure of nerve’ in the family movement, abandoning the role of the family in schizophrenia in the face of psychiatry's assertion that all serious mental illnesses had nothing to do with the family. Other important changes separating the family movement from psychiatry occurred as well. Bowen theory is anchored in biology and evolution, but it is not a biological paradigm. Maintaining solid connections to the scientific disciplines are important for keeping the theory an open system. The recent emergence of systems biology and systems medicine could challenge psychiatry's allegiance to the biological paradigm and bring family systems theory centre stage in the discipline. These new disciplines may also arrive at a systems theory of the individual that can be integrated with family theory, powering a paradigm shift in medicine as a whole.     

A Cross-Cultural Assessment of Familial Factors in the Development of Female Homosexuality

Nonclinical samples of 224 heterosexual and 205 homosexual females were interviewed with regard to their recalled childhood experiences in Brazil, Peru, the Philippines, and the United States. Twelve items were used to examine differences between heterosexual and homosexual females. These are: "normal" family, absent motherlfather, wanner parent, stronger parent, hostile father, hostile mother, detached/distant father, detached/distant mother, seductive mother, seductive father, father's attitude toward sex, mother's attitude toward sex. Seven items produced no significant differences between homosexuals and heterosexuals in any of the four societies. Another five items resulted in some signif~cant differences between these groups; however, these differences were inconsistent in all four societies. Combining the data for all four societies resulted in only one item-the detacheddistant mother-exhibiting signif~cant differences between homosexual and heterosexual groups. It is not clear whether the detachedldistant mother is a cause of or a reaction to emerging homosexuality. On the whole, these cross-cultural data provide little support for the role of familial factors in the development of female homosexual orientation.     

Pediatric Chronic Illness Management: A Qualitative Dyadic Analysis of Adolescent Patient and Parent Illness Narratives

In pediatric chronic illness, little is known about the relational interactions between adolescent patients, parents, and illnesses and how they influence self-management of illness. We conducted interviews with 32 individuals (16 dyads) representing adolescents diagnosed with a chronic illness and their primary parent who had been referred to a psychosocial treatment program for challenges with illness management. Interviews were conducted individually and analyzed dyadically using grounded theory to better understand the relational processes that may be contributing to illness management difficulties. Results include a theory of patient–parent illness responses and how parental illness meanings play a role in adolescent self-management. Results can be used to better understand and treat family relational patterns that may be influencing pediatric illness management challenges.     

Social Relations Model Analyses of Perceived Self‐Control and Trust in Families

How do people know which family member is trustworthy? In this study, the authors tested the hypothesis that people use their perception of a family member's self‐control as an indicator of his or her trustworthiness. Eighty‐four Dutch families consisting of 2 parents and 2 children completed questionnaires assessing each family member's trust in and perceived self‐control of the other 3 family members. This full‐family design enabled the authors to examine their hypothesis in horizontal relationships, between family members of equal status (i.e., parent–parent and sibling–sibling relationships), and vertical relationships, in which partners have unequal status (i.e., parent–child and child–parent relationships). Consistent with the hypothesis, Social Relations Model analyses showed that being perceived as having higher self‐control is related to greater trustworthiness among adults and children in the large majority of horizontal and vertical relationships (10 out of 12). These findings highlight that perceived self‐control is an important factor by which to gauge trustworthiness in families.     

Mahler applied

Conclusion It is crucial to recognize that individuation is not a smooth or painless process. Indeed, some of the pressures on the individuating client as a member of a family come from his spouse and the family system. Marriage itself is a partial symbiosis out of which one or both members individuate, with the ideal being an optimal distance between them. The developmental approach to the family notes that there is a crisis in the life cycle whenever there is a passage from one stage to the next, i.e., birth of the first child, the last child beginning school, the last child leaving home. The adolescent's attempt to separate from his family is another well-known crisis situation, at times being expressed through schizophrenic breakdown in the family. The extreme on the continuum of resistance to individuation comes from the schizophrenic family, where individuation creates excessive anxiety, as differences among members upset the homeostatic balance. It is the task of the therapist to avoid being drawn into the family's symbiotic system, and instead to aid the client in achieving a higher level of differentiation.What is apparent in studying Mahler's work is the complexity of the entire process of becoming an individual. Working with clients who are striving for mastery in this area, and with those who fear it, is further dramatic proof that separate functioning demands great psychic investment as well as a significant amount of time. Mahler has provided clinicians with a valuable framework for intervention and guidelines for assessment of individual growth.     

A Family Matter

Abstract

The 2004 debate over civil marriage for same-gender couples highlights issues faced by mixed-orientation couples after one of the spouses comes out as gay, lesbian, or bisexual. The disclosure becomes a family matter as their spouses and children cope with the new information and antigay attitudes. The majority of couples divorce. A minority stays married for three years or more by developing strategies that enhance the relationship, offset outside pressures, and sustain the family circle. Peers provide the most support, while therapists are often unfamiliar with sexual orientation, mixed orientation couples, or societal attitudes that impact families with a gay, lesbian, or bisexual parent. This article provides that information so that professionals can help these couples improve the quality of their lives and develop skills to create a future in which homosexuality, same-gender relationships, and gay parenting are more widely accepted and legalized. This development would decrease the number of mixed-orientation marriages with closeted spouses and increase the potential for both types of families to form lasting marriages and strong family units.     

Does Family Intervention for Adolescent Substance Use Impact Parental Wellbeing? A Longitudinal Evaluation

Adolescent substance abuse is a common problem and family interventions are emerging as a strategy to prevent it and assist family coping. The effectiveness of a prevention‐focussed family intervention was evaluated for its secondary impacts on improving parental mental health and family functioning. Twenty‐four secondary schools in Melbourne Victoria were randomly assigned to either a control condition or an intervention titled Resilient Families. The two intervention levels analysed were: (1) a parenting booklet only and; (2) combining the booklet with face‐to‐face parent education sessions. Parent surveys at baseline were followed up one year and four years later. Repeated‐measures analysis (n = 560) found parents attending parent education demonstrated reductions in mental health symptoms, however this had negative effects on family cohesion and no impact on family conflict. These findings were interpreted in terms of parent education assisting parent mental health by promoting assertive parenting styles that may increase adolescent‐parent tension by encouraging firmer parental boundaries and strategies to reduce adolescent substance use.     

Who Does What When Partners Become Parents:

Forty-seven couples who were first-time parents were assessed in late pregnancy and again at 6 and 18 months postpartum. Fifteen couples not yet decided about having a baby were assessed at equivalent times. Actual involvement in household, decision-making, and childcare roles was determined by responses to a 36-item "Who Does What?" questionnaire. Psychological involvement in parent, partner, and worker roles was also determined, as was each partner's satisfaction with behavioral and psychological involvement in each domain. On the basis of global analyses, previous studies have suggested that new parents adopt more traditional roles. Item analyses indicated that men's and women's roles change in both traditional and nontraditional ways during the transition to parenthood, depending on the item and the time of assessment. Measures of individual and couple adaption were also obtained: self-esteem, parenting stress, and marital satisfaction. Men's involvement in family tasks was correlated with their own or their wives adaption in pregnancy but became linked with adaptation at 6 months postpartum. However, at 18 months after birth husbands' involvement in family tasks was correlated only with wives' adaptation. For both parents, satisfaction with family task arrangements becomes correlated with self-esteem, parenting stress and marital quality after childbirth; these measures of adaptation are more closely linked with role satisfaction than with actual sharing of family work.     

Happy Spouses,Happy Parents? Family Relationships Among Finnish and Dutch Dual Earners

In this study links between spousal and parent‐child relationships among Finnish (n = 157 couples) and Dutch (n = 276 couples) dual earners with young children were examined using paired questionnaire data. Variable‐oriented analyses (structural equation modeling with a multigroup procedure) supported the spillover hypothesis, as higher levels of satisfaction in the spousal relationship were related to higher quality in the parent‐child relationship and lower parental role restrictions. These connections did not differ by gender or country. With family typological analyses (mixture modeling), 4 family types were identified: families with satisfying relationships (73.4% of the families), families with unsatisfying parent‐child relationships (13.4%), and families with either dissatisfied men (6.0%) or dissatisfied women (7.2%).     

Intergenerational Contact in Chinese Families: Structural and Cultural Explanations

Although the determinants of intergenerational contact have been well documented in Western countries, we know virtually nothing about the situation in China, a country that has recently experienced unprecedented socioeconomic and demographic change. This study analyzed the frequency of (a) visits and (b) other contact (phone, text message, etc.) in a representative sample of 16,715 adult child–parent dyads, focusing in particular on the role of migration as well as children's gender, marital status, and education level. Adult children generally maintained intensive social relations with parents, although distance was a major barrier to face‐to‐face contact. Sons visited more often than daughters, but daughters were more likely to stay in touch by other means. Moreover, the strength of parent–daughter ties was strongly dependent on education level. These findings suggest that women's empowerment and the spread of mobile technology have created new opportunities for intergenerational solidarity.     

Examining the Effects of Parental Absence on the Academic Achievement of Adolescents: The Challenge of Controlling for Family Income

Increasingly, researchers are concerned about how to best control for family income when examining the effects of parental divorce and the death of a parent on the children's academic achievement. Some researchers have argued that a predissolution control is preferable over a postdissolution control for family income, because parental divorce or the death of a parent nearly always causes family income reduction. Using the National Educational Longitudinal Study 1988–92 data set, this study has examined whether using a predissolution control for family income yields a different pattern of effects from when a postdissolution control is used. The results indicate that using a predissolution control rather than a postdissolution control for family income does yield a different pattern of effects.