Walk-in Together: A pilot study of a walk-in online family therapy intervention

Many Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk-in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof-of-concept study investigating the acceptability and short-term effectiveness of an online walk-in family therapy service, Walk-in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk-in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre-session, post-session, and at 6 weeks follow-up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi-structured interview data. Post-session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post-session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well-received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk-in delivery model. This proof-of-concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk-in, telehealth model to meet the rising demand for therapeutic support for families in distress.     

Single‐Session Approaches to Therapy: Time to Review

In 2001 Bloom produced a comprehensive review of single‐session approaches to therapy (SST). In his paper he outlined the concept of single session therapy and considered the evidence that could be used to support implementation of single session approaches. At the time, Bloom's was probably the most comprehensive review of research on single session therapy available: he considered papers that provided overviews of approaches to developing and delivering single‐session treatment, as well as papers that used controlled and uncontrolled methods to evaluate outcomes. What I will do in this paper is to informally review the literature on single session therapy that has been published since Bloom's 2001 paper. The paper is not intended as a formal review or meta‐analysis of research data, partly because the field still does not have such methodological rigour.     

Workforce training in family therapy and systemic practices: An evaluation framework and case study

Internationally, while the interdisciplinary field of family therapy and systemic practices is well established and evidence for therapeutic impact is advanced, evaluation of training and measurement of its impact lags behind. This paper addresses this gap, utilising a single case study at the Bouverie Centre, the largest family therapy and workforce development service in Australia. We describe (a) the scope of workforce training and implementation at the Centre, (b) the development of our training research and evaluation framework, and (c) standardised data collection methodology, including a pre-post training reflective survey. Collectively, this work comprises our current evaluation framework through which we will subsequently examine training impact. Future research and practice recommendations are offered to address challenges to workforce training evaluation and progress efficacy of family therapy training.     

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.     

Maintaining the Gains: What Worked in the Year after Brief Family Therapy

Brief family therapy, including single session therapy, is widely used to provide a timely and responsive service for children with emotional and behavioural problems. However, there is surprisingly little information about how these children and families fare in the longer term. The brief family therapy program described here was directed toward children with problems of moderate severity. Child Behaviour Checklists (CBCL) were completed by parents before, three months after, and twelve months after therapy; 110 parents also participated in semi‐structured telephone interviews twelve months after therapy. Parents' CBCL ratings showed a significant decrease in children's problems after therapy, which were maintained over the subsequent year, although some children continued to experience difficulties. Parents generally found brief therapy a helpful experience. Ways to strengthen the preventive possibilities of brief therapy work will be identified at both a practical and conceptual level.     

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.     

A Network Therapy Clinic for Clients with Intellectual Disability

Over the past 30 years a systemic approach has been applied to complex cases involving intellectual disability and behaviours of concern. This paper describes a model that draws on systemic family therapy and network therapy as well as the use of a reflective team. A single session intervention was provided for families of people with intellectual disability. A systemic consultation was used as a pre‐session meeting for professionals working with the family. The systemic consultation and single session therapy allowed the family and the professional network to gain insight. Involving the professionals in the therapy session also enhanced the alliance between professionals and family. This approach assists everyone involved in the case to find a way to progress.     

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.     

CHANGING FAMILIES/CHANGING COMMUNITIES

Scholars writing about community in recent years have been more likely to lament its passing than celebrate its exemplars. What's missing in this recent revival of interest in community is a systematic link with work–family issues and, in particular, an explicit recognition that women's and men's work–family lives have changed dramatically in the post-World War II era. We investigate the consequences of structural shifts in our family and work lives for a sample of elite, managerial women in dual-earner marriages, a population for whom work and family concerns are both immediate and salient. Understanding changing definitions of, and trends in, family and work can provide a useful lens through which we can profitably address recent debates about the decline or resurgence of community and civic society. Our findings suggest that, although conceived differently than in previous decades, family remains central to our respondents’ sense of community and structures their civic engagement. In contrast with previous generations of women, however, work is also important, for defining women's sense of self and community and for offering an alternative venue for community service.     

‘I'm not a family therapist. OK?’ Working Constructively with Families in Aged Psychiatry

This paper reports on the first phase of a larger study aimed at investigating factors hindering family work and exploring ways to improve the amount and quality of family contact within a community aged mental health service in Melbourne, Australia. During the first phase of the project, 28 mental health professionals were interviewed about their views and experiences. Interviews were transcribed, coded, and analysed in terms of repeating themes. The range of attitudes, beliefs and feelings about family work is summarised in this paper. Polarities emerged around questions of whether or not to engage family members, and if so, what function family work fulfils. The interviews also provided useful information on clinicians' beliefs about what would increase the possibility of family work. The paper concludes with a discussion about how to recognize and value family work in this area and target sustainable interventions during the second phase of the study.     

‘I Will Not Leave My Baby Behind’: A Cook Island Māori Family's Experience of New Zealand Māori Traditional Healing

Traditional healers in many parts of the world have used family focused understandings and interventions well before the emergence of western family therapy theory and practice. This paper gives a detailed account of New Zealand Māori traditional healing work with a Cook Island Māori family in which the eldest daughter was in considerable distress as were her family, who believed that she had become maki tūpāpaku (possessed). This account is told from the perspectives of the child psychiatrist, the traditional healer and the mother of the family. While the intervention bears a superficial resemblance to western family therapy approaches, the theoretical foundation reflects the traditional healer's New Zealand Māori world views in which spiritual understandings are paramount, and concepts of mana, tapu and mauri ¹ guide him in the family healing process. The single session described here can be viewed as an indigenous family therapy intervention involving six generations of family members, both living and deceased, in the one room. Conclusions: Indigenous communities have called for traditional healers to be employed alongside child mental health workers and family therapists who work with their communities. Close and sincere collaboration between an indigenous traditional healer and a health professional can offer a family in distress healing possibilities that may not be available to them in conventional child mental health or other family therapy settings.     

Implementing Single Session Family Consultation: A Reflective Team Approach

Setting up and implementing a single session family consultation in a specialist child and adolescent mental health setting, which for a long time has been an organisation and culture that has undertaken a traditional detailed child and family assessment and treatment, brings with it challenges. This paper will look at the history of single session consultation within the field of child and family services and, in particular, child and family services in mental health. It will also look at the development and implementation of a single session therapy program, and associated research on the effectiveness of the program, at the Alfred Child and Youth Mental Health Service. Clinical examples will assist in illustrating the program and its model and structures. Lastly, it will review the research data and compare this with other research data in the field.     

Single Session Interventions: An Example of Clinical Research in Practice

Single session consultations seem to be an efficient and effective way of providing therapeutic interventions at a time of increasing demands for services and shrinking resources. Though ‘one-off’ consultations have a long clinical history, specific interest in their use was sparked by Talmon's (1990) observation that 78% of his clients who had had only one consultation had experienced improvement in their presenting problems. Several Australian studies have supported Talmon's advocacy of this approach (Boyhan, 1996; Hampson, O'Hanlon, Pentony and Cramby, 1994; Price, 1994) but have significant methodological flaws. The present study used a pre–post methodology to assess the effectiveness of single session interventions and explored whether family dynamics impacted on changes in the presenting problem and in level of coping. The results indicated significant changes in both. Family pride or morale was identified as a major factor in positive response to the interventions. The implications for the use of single sessions and for further clinically based research are discussed.     

Preserving Family Therapy's Legacy

Originating as a plenary address, this article reviews the enduring contribution of family therapy, and asks how it might best be preserved into the future, given that family therapy itself is no longer seen as ‘newsworthy’. The author makes three recommendations: that all future social workers be trained to conduct a three‐session structured family assessment; that all future family therapists be required to participate in a Yalom‐type group therapy experience; and that one member of every child mental health and child protection team be trained to convene and chair interagency case conferences capable of building trust and working towards open communication. A rationale for the three recommendations is provided, in terms of key principles common to family and group work.     

Group Couples' Intervention to Improve Sexual Health Among Married Women in a Low‐Income Community in Mumbai,India

This article describes the design and implementation of a group couples' intervention focused on improving women's sexual health as a component of a multilevel community, clinical, and counseling intervention project conducted in association with a gynecological service in a municipal urban health center in a low‐income community in Mumbai, India. The group couples' intervention involved four single‐gender and two mixed‐gender sessions designed to address the dynamics of the marital relationship and establish a more equitable spousal relationship as a means to improve women's sexual and marital health. Involvement of men presented a major challenge to couple's participation. For those couples that did participate, qualitative findings revealed significant changes in couple and family relations, sexual health knowledge, and emotional well‐being.     

The Psychiatrist's Role in Implementing an Open Dialogue Model of Care

The Open Dialogue approach is a family‐oriented early intervention model for mental health problems developed in the health district of Western Lapland, Finland. Since the 1990s the psychiatric service system in Western Lapland Health Care District has been organised according to Open Dialogue principles and applied to the treatment of any mental health concerns. The Open Dialogue approach considers the client and their family as active participants rather than as objects of treatment in its planning and implementation with a psychotherapeutic focus. In daily work, the responsibility for the treatment process is shared with the case‐specific team. The model of care requires a dialogical orientation from all staff members, psychiatrists included, to interact with the team and the client's network. In this article I describe the role of the psychiatrist in implementing an Open Dialogue model of care in psychiatric services leaning on my experiences of clinical work in the adolescent psychiatric team in Western Lapland.