The Structure of the Families of Schizophrenics

In the families of schizophrenic patients everything is subordinated to the neurotic or psychotic needs of one of the parents, and the whole family then works together to stop that parent from becoming psychotic. The other parent must become completely subjugated or withdrawn and leave the family under the domination of his spouse. This becomes a rigid system in which the patient's role is to “feel nothing, do nothing, and be nothing”, and any minor change in him becomes a major threat to the integrity of the whole family. It is when he can no longer maintain this role that the person becomes clinically schizophrenic. Some of the difficulties in treating schizophrenic patients in individual or family therapy are discussed.     

Treatment of psychotic children and adolescents: A psychoanalytic social work approach from the Federal Republic of Germany

This paper offers data from the inpatient treatment of four psychotic adolescents in a clinic in Tubingen, in the Federal Republic of Germany. The author describes crucial episodes in therapy of each, and includes his own physical sensations and reactions, his dreams, and the thinking and feeling that determined his responses to these young patients. This way of working is a non-medical form of psychoanalysis.     

The White Whale: A Case Study

Towards the end of counselling with Steven, a 13‐year‐old Aboriginal adolescent, he dreamed of being lost at sea and then found by a white whale. The whale carried him to safety; specifically, into the care of his current foster family. This ending is full of symbolism and seems to promise positive and uncomplicated outcomes. However, counselling is rarely straightforward, and this case study is no exception. It explores a complex journey though therapy, full of challenges and discomfort, not only for Steven and myself, but also for the variety of other supportive players in his life. The outcome, although nowhere near as dramatic as his dream, I believe reflects meaningful change for this young man.     

Peach Trees Grow in the Spaces Between People: Counselling Practices in the Territory of Violence

In this paper the authors reflect on how therapeutic practices wove a community of care and concern with a young man in South Africa who was at risk of anger ruling his life. A counselor and outsider witnesses participated in responding to the problems the young man and his family faced. The authors discuss the steps they took in the therapeutic journey and describe how their personal and professional lives were shaped by this collaboration. This work inspires and sustains their enthusiasm in seeking to understand how to best respond when positioned to counsel.     

Sadness and Chronic Illness: A Conversation with Bruce Perham

Bruce Perham is a social worker and narrative therapist who works at Alzheimers Australia Vic., the peak body representing the interests of people affected by dementia. He previously worked at an adoption agency, the Spastic Society (now Scope), and the Multiple Sclerosis Society. Bruce trained in family therapy in Melbourne and in narrative therapy with Michael White at the Dulwich Centre. Bruce has created an extensive range of written and video resources for people with dementia and MS and their family members. He describes how his family of origin, his resultant personal struggles as an adult, and narrative therapy, have profoundly influenced his work with people with chronic illness and their families, in particular, his approach to sadness.     

Lessons From ‘The Hitting Place’: Reflections of a Family Therapy Novice

This case study is an account of a post‐traumatic family attempting to come to terms with life after violence, and the effectiveness of family therapy in supporting this transition. The fighting between two young girls had maintained the violence in the family dynamic and their highly anxious adolescent brother remained unable to let go of his protective position and move forward with his own life. The backdrop of the case was a novice family therapist and a mother with borderline traits who found it difficult to keep the therapeutic work within the bounds of the therapy sessions. Despite these difficulties meaningful change could be seen after only seven sessions of family therapy.     

Despite years of failed treatments,patient cuts back on drinking

A social worker, a mother and conference calls all united for what looks at this time like a happy outcome for one young man, despite the failure of multiple treatments. Residential treatment, individual counseling, Vivitrol, AA attendance, an interventionist and a stint at an unlicensed rehabilitation center all may have helped in this case study of a young man — age 36 by the time he started working with Patrick Doyle, a social worker who is a family coach enlisted by the patient's parents. But ultimately, they all failed, and the young man was in risky territory, with binges and blackouts. What saved him was his mother's decision to stand up to the insistence by the “recovery team” on total abstinence. The recovery team included Doyle, who recounted the story to ADAW last week, the parents, the therapist, and the interventionist.     

Mental illness,partial hospitalization,and the family

Summary When illness is socially defined, the task of therapy is to enable the patient to move from a sick role to one of maximal social functioning. In a day hospital setting, methods are explored to involve a patient with his family both directly and indirectly. Thus the patient is supported both in the treatment milieu and when he is at home. Not only the patient, but the family, is vulnerable at this time and each must be helped to make parallel and complementary shifts in interpersonal behavior. To view the family solely as a resource for the support of the ill member and his treatment is to fail to accept the need of the family as a whole for reorganization and strengthening.     

The right stuff for early intervention in psychosis: time, attitude, place, intensity, treatment, & cost

This article shares information about an exciting new approach in psychiatry. During the past 12 years, the authors have worked with young people experiencing their first episode of psychosis. It is clear that intervention at the earliest stages of psychotic illness allows clinicians to make a significant difference in the lives of young people and their families. This article summarizes current intervention strategies, which are considered best practice guidelines for early treatment.     

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.     

The loyalty bind and sacrifice of the self: Family treatment of adolescent schizophrenia and schizophreniform disorder from a psychodynamic-systemic perspective

This article reviews treatment of families with a schizophrenically functioning adolescent from a psychodynamic systemic perspective. Systemic and psychoanalytic conceptions of family binding and the sacrificial nature of schizophrenic dysfunction, both on an intrapsychic and interpersonal level, provide the theoretical foundation for a multi-dimensional approach to treatment. This treatment approach is predicated on reframing of the adolescent's behavior, a co-therapy model of reparenting and multi-family group therapy to resolve the separation-individuation impasse characteristic of such families. The case of a 16 year old boy and his family is used to illustrate the concepts discussed.At the time this was written the author was a family therapist with Child and Adolescent Services, Coliseum Psychiatric Hospital, Macon, Georgia. He wishes to express appreciation to Dennis Jones, Ph.D., Program Director: A. Allison Grant, M.D., Clinical Director, and the staff of the adolescent unit.     

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 variation in family background amongst young homeless shelter users in Denmark

This article analyses variation in the family background of young homeless people in a cohort of young Danes. The study is based on administrative data for individuals who were 18 years old in 2007 and their parents. Homelessness is measured by shelter use over a five-year period. Data also cover education, employment, mental illness, substance abuse problems and placement outside home in childhood for the young persons, and education, employment, civil status, mental illness and substance abuse problems for their parents. A cluster analysis identifies two groups, each comprising half of the young shelter users. In the first group, social marginalisation is transmitted between generations, as most parents have low education and mental illness or substance abuse problems, and are unemployed. In contrast, the young people in the second group come from wider socioeconomic backgrounds, with few of their parents having mental illness or substance abuse problems. These young people develop psychosocial problems and become homeless without strong predictors from their family background. Amongst the young shelter users from families with severe social problems a higher share are in the Not in Education, Employment or Training group. They also have more shelter stays, compared to young shelter users from families with fewer social problems.     

Sometimes Words Just Ain't Enough – Enhancing the Contribution of Children in Therapy through Creative Expression

The meaningful inclusion of children in family therapy is an ideal that therapists readily align with and yet struggle to implement effectively. Within a practice that relies heavily on verbal expression, young children provide a unique challenge for therapists, who require developmentally appropriate opportunities for the child to express, document, and share his or her experience in all its richness and colour. In this paper the author utilises art therapy to support greater inclusion of children in family therapy by capitalising on their creative talents and facilitating the child's visual story within the family dialogue. This can assist in the formulation and treatment of systemic issues.     

Self-regulation of distance in supportive psychotherapy

The authors present the case of a schizophrenic man treated in the setting of a supportive care clinic. The course of treatment from beginning to termination is illustrated by treatment vignettes and by excerpts from the patient's letters to the therapists. Case discussion centers around the handling of the classic schizophrenic conflict over intimacy versus isolation. The authors stress that the therapists must be acutely sensitive to the patient's need and ability to regulate his or her own emotional and therapeutic distance over the course of treatment. They make a case for utilizing this conceptual framework in the treatment of chronic psychiatric patients in supportive clinic settings.     

Interview With Michael Kerr

The following article was written by Dr Michael Kerr in response to questions put to him by Barbara Fraser; Linda Mackay and Lu Pease when he visited Australia two years ago. These three family therapists took it upon themselves to prepare this interview in recognition of Dr Kerr's unique vantage point on Bowen Theory and family therapy. Michael Kerr was trained by Murray Bowen in the 1970s and subsequently went on to work as faculty at the Georgetown Family centre. He succeeded Bowen as director of the centre where he has devoted his professional life to the understanding, application and extension of theory. He is the co‐author with Dr Bowen of Family Evaluation: An Approach Based on Bowen Theory (Kerr & Bowen, 1988), which remains the most esteemed text on this theory. He is also the editor of Family Systems: A Journal of Natural Systems Thinking in Psychiatry and The Sciences. Bowen's Family Systems Theory grew out of years of research from the 1950s‐1970s, which included observations of inpatient families with a schizophrenic member and using data from Bowen's own interactions with his family of origin (Bowen, 1978). The theory continues to be influential in family therapy with its most well‐known contributions being the process of triangling, the intergenerational transmission of family patterns and the concept of differentiation of self. (Brown, 1999). The following discussion from Dr Kerr brings a fresh perspective on the current applications and developments of this systems theory     

Intimacy,Men and Their Relationships

This paper is an attempt, using one case example, to highlight the struggle many men have with masculinity. The presenting problem for this young man, was his belief he had a small penis and was not a “man”. This resulted in him closing off his life more and more. The connection between intimacy and masculinity and the ideas that proved helpful for this man consequently to explore relationships will be discussed.     

Parental Grief and Serious Mental Illness: A Narrative

Serious mental illness is associated with substantial personal and interpersonal distress and life disruption for the sufferer and for his/her family. A common response to having and caring for a family member with a serious mental illness is feeling loss and grief. This paper presents a representative narrative that attempts to capture the essence of the experience as conveyed by 22 parents of adult children with a serious mental illness. The implication of the narrative is examined.     

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.