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.     

Depression,the Family,and Family Therapy

The potential contribution of family therapists to the treatment of depression remains underdeveloped. Family therapists need to articulate how changes in family functioning might benefit depressed persons, as well as how other problems in the families of depressed persons tend to go unrecognised. Furthermore, family therapists need to be alert to how undetected depression in adults and children may interfere with their ability to meet their goals with families who seek therapy for other persons. This article provides family therapists with (1) an overview of the nature and experience of depression; (2) an introduction to antidepressant medication; (3) a summary of research findings relating depression to its family context and (4) a brief overview of developments in the marital and family treatment of depression.     

Therapeutic change in Colombian families dealing with violence: therapists, clients, and referring systems in conversation

There is a gap in the Marriage and Family Therapy literature regarding clients', therapists', and family judges' theories of change in relational therapy for family violence. We conducted in-depth interviews with eleven court-referred families, their therapists, and two family judges in Bogota, Colombia. Interviews focused on their expectations of therapy outcomes, their understanding of change, and their evaluation of individual and relational therapy outcomes. We followed a grounded theory approach to data analysis. Analyses showed that therapists, family judges, and clients hold different expectations and theories regarding therapeutic change. Findings are discussed based on existing research on clients' and therapists' ideas about change. Implications for future research and practice are presented.     

INFLUENCES ON THEf INCLUSION OF CHILDREN IN FAMILY THERAPY BRIEF REPORT

This study examined factors that influence family therapists to include children in or exclude them from therapy sessions. We hypothesized that therapist comfort, child problem type (internalizing vs. externalizing), family composition (one- vs two-parent families), and presenting problem (child-oriented problem vs. adult-oriented problem) affect therapists' inclusion of children. A survey of clinical members of AAMFT found that half of the therapists excluded children on the basis of their comfort and that those who felt more comfortable were more likely to include children in sessions. Therapists included children more frequently in cases of an internalizing vs. an externalizing child, more with single-parent than two- parent families, and more often when the presenting problem focused on a child than on an adult. Implications of the findings are discussed.     

THE VOICES OF CHILDREN: PREADOLESCENT CHILDREN'S EXPERIENCES IN FAMILY THERAPY

Although family therapists often include children in therapy sessions, they rarely consider the child's wishes regarding participation or ask children for their impressions of therapy. In this study, 16 children between the ages of 5 and 13 who had participated in at least four family therapy sessions were interviewed to determine their perspectives on the experience. The children made it clear that they wished to be involved in a meaningful way in therapy and that they wanted to come to sessions even when they were not the focus. Feedback from these children is used to suggest ways family therapists might enhance their effectiveness with families with children.     

Action-oriented evaluation of an in-home family therapy program for families at risk for foster care placement

The purpose of this study was to conduct an action-oriented evaluation of an in-home family therapy program serving families deemed at risk for the placement of children in foster care. In this study, feedback was solicited from both clients and therapists. Results indicate "duality" associated with several aspects of in-home family therapy, including the opportunity to observe families in their own homes versus the vulnerability some families feel when therapy is conducted in-home; therapists suggesting that sufficient training is required for in-home family therapy to be effective versus clients' opinions that therapists' lived experiences are more relevant; and the importance of the therapeutic alliance versus feelings of abandonment upon termination. Implications for researchers and practitioners are discussed.     

The theory,structure, and techniques for the inclusion of children in family therapy: a literature review

Many barriers prevent therapists from including young children in family therapy, despite the theoretical belief that every family member should be present. Although there is a wealth of literature describing how to include children, the information has not been compiled in a way that is easily accessible to therapists. In this article, we report the findings of an exhaustive and systematic literature review of 64 publications, published between 1972 and 1999, related to including children in family therapy. The purpose of this article is to offer therapists a succinct compilation of theoretical, structural, and practical aspects as well as a comprehensive listing of specific techniques for including children in family therapy.     

DO GENERAL TREATMENT GUIDELINES FOR ASIAN AMERICAN FAMILIES HAVE APPLICATIONS TO SPECIFIC ETHNIC GROUPS? THE CASE OF CULTURALLY‐COMPETENT THERAPY WITH KOREAN AMERICANS

To serve Korean American families effectively, marriage and family therapists need to develop a level of cultural competence. This content analysis of the relevant treatment literature was conducted to discover the most common expert recommendations for family therapy with Asian Americans and to examine their application to Korean Americans. Eleven specific guidelines were generated: Assess support systems, assess immigration history establish professional credibility, provide role induction, facilitate "saving face," accept somatic complaints, be present/problem focused, be directive, respect family structure, be nonconfrontational, and provide positive reframes. Empirical support (clinical and nonclinical research) and conceptual support for each guideline are discussed, and conclusions are reached regarding culturally competent therapy with Korean American families.     

Cancer in the Family: Review of the Psychosocial Perspectives of Patients and Family Members

As advances in cancer care have led to more treatment options and longer survival for cancer patients, a focus on quality of life for patients and their families has gained importance. This review provides a discussion of stress and coping theory, documents the relevance of this topic area for social work practice, and illuminates the results of a literature review by emphasizing the perspective from which research was collected within the family system. Recognizing the impact of cancer on the lives of patients, their partners, children, and the family as a whole is an essential factor in providing appropriate and adequate psychosocial services to families facing cancer.     

Marriage and family therapists working with couples who have children with autism

Current research about families and couples who have children with autism is discussed using the Double ABCX model as a guide. A case study is presented along with recommendations for therapists who work with couples who have children with autism. Marriage and family therapists are encouraged to use the Double ABCX model as both an assessment tool as well as for intervention. More research and effective therapists in this area are needed in order to keep up with the rising rates of families that include children diagnosed with autism.     

Every Dot has a Meaning

Family therapy in Australia has recently begun a conversation with the indigenous people of this country. Part of this dialogue has involved family therapists listening to the stories of violence and oppression perpetrated against the Aboriginal people under the name of “protection”. This article is part of the ongoing exchange between family therapists and Kooris documenting the suffering of “the stolen generation”. Here two young people removed from their families as small children and raised in the same Aboriginal children's home, speak personally through their art, of an agonising search for family and cultural identity.     

Lesbian Parenting: Insiders' Voices

Lesbian parenting has entered the public arena over recent years via debates regarding access to fertility services and adoption, legal recognition of same‐sex parents and children's rights (McNair, 2002). Research in the area has been published for over 20 years, with an increasing shift towards delineating diversity rather than proving the legitimacy of these families. The ANZJFT — the major mouthpiece for Australian family therapists — has made curiously little contribution to the literature on lesbian parenting. The lack of discussion leaves trainees and family therapists largely ignorant about the lived experience of lesbian family life. This paper goes some way to filling this gap. We present data gathered from 151 Australian lesbian parents who answered questions about their own and their families' perceived strengths. Despite the constraints and challenges of living within a heteronormative and homophobic society and dealing with discrimination and legal, political and social non‐legitimation, this group of lesbian parents expressed great pride in raising well‐adjusted and happy children. They also described their families as thoughtfully planned, proud, accepting and celebratory of diversity and difference, flexible in gender roles, and as having interesting, supportive, extended kinship networks that included a wide range of positive role models for their children.     

Treading the Path of Anticipatory Bereavement: Working with Families with a Dying Member in an Acute Care Medical Setting

The aim of this paper is to consider issues related to working with families with a dying member in an acute medical setting, using the framework of the Bower Place family therapy approach. The literature on individual and family anticipatory bereavement processes is reviewed and the Bower Place methodology of family therapy is outlined. A case example is used to illustrate the application of the methodology to a family facing the death of one of its members. The author highlights the need for therapists to consider second order cybernetic issues when working in this context.     

A Mixed Methods Exploration of Single Session Family Therapy in a Child and Adolescent Mental Health Service in Tasmania,Australia

Single session therapy (SST) is grounded in the belief that clients and families can effect change after one therapeutic encounter, using their own resources, with brief support and assistance from therapists. SST has been found to be an effective intervention for children, young people, and their families presenting with a wide range of difficulties. Research in child and adolescent mental health has shown that over 50% of families find one SST encounter is enough with no need for further specialist input. This study aims to explore family member experiences of SST (undertaken as single session family therapy and termed hereafter SSFT) as an initial intervention in a regional child and adolescent mental health service (CAMHS), specifically in terms of worry, confidence, and satisfaction outcomes. An exploratory, mixed methods convergent design was utilised using a combination of open questions and Thurstone scales. All eligible family members were invited to complete questionnaires before and after the SSFT, asking about level of worry, confidence, and overall satisfaction with SSFT. Quantitative and qualitative findings indicated most family members had a positive experience of SSFT, although differences were found between young people, parents, and siblings. Overall, family members’ level of worry decreased, while only parental confidence in managing the presenting issue(s) increased. Over half of the families did not require further contact with CAMHS following the SSFT. Our findings support previous research that SSFT is an effective, family-inclusive, and well received intervention for a variety of mental health issues facing children and young people. SSFT could be considered a beneficial and well received first response for the majority of CAMHS clients, which prioritises a family-inclusive approach. Future research could focus on attaining a more in-depth understanding of individual family member experiences with a view to improving SST delivery.     

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.     

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.     

Considering justice: an exploratory study of family therapy with adolescents

Feminist approaches to therapy with adolescents emphasize an empowering focus on the strengths of adolescents while simultaneously insisting that therapists become aware of their own biases toward today's adolescents. However, a review of the family therapy literature finds little mention of feminist approaches for addressing injustices (e.g., family scapegoating, negative societal views of adolescents, and gender oppression) that arise in family therapy with adolescents. Therefore, this study explores clinical approaches and resources suggested by a surveyed group of self-identified feminist family therapists. In addition, we also recommend several approaches and resources that will aid family therapists in creating a more just climate for family therapy with youth.     

Are the Children Playing Quietly? Integrating Child Psychotherapy and Family Therapy

Over many years, family therapy training programs have not included the engagement of children under seven. John Byng-Hall wrote in 1986 that family therapists could learn about understanding young children from child psychotherapists. It has long been my practice to include young children when working with families. This article describe ways of working that include young children's play as relevant information. I hope to encourage other child psychotherapists and family therapists to find better ways of integrating skills.     

Family Mediation: A Guide for Family Therapists

Family therapists often see separating parents who need to agree on co‐parenting arrangements. This article provides a guide to current research and practice in family mediation. The limited available research suggests mediation is a useful approach for some separated parents and their children, but often is not successful with highly conflicted parents, parents with mental health problems, parents struggling to accept the separation from their partner, or parents with unrealistic co‐parenting expectations. We analyse ways in which mediation might be enhanced, and discuss the potential roles of family therapists to support separating families to negotiate positive co‐parenting.