THE EFFECTIVENESS OF FAMILY THERAPIES FOR SELECTED BEHAVIORAL DISORDERS OF CHILDHOOD

This article reviews the scientific evidence for the effectiveness of family-based aproaches in the treatment of selected childhood behavioral disorders. Although limitations certainly exist, family interventions have consitently improved child and, in some cases, parent functioning in families with children presenting with conduct disorder (CD) and autism. Parents and other family members also directly benefit from child-focused interventions, gaining in knowledge, child management skills, and attitudinal improvements. Longh-term follow-ups indicate that CD and autistic children achieved lasting gains. Similarly, the research on attention-deficit/hyperactivity disorder (ADHD) indicates that parent training improves child noncompliance and aggression yet does not consistently affect core symptoms of ADHD. There is no evidence that adding short-term family interventions improves ADHD child functioning beyond improvements from the use of psychostimulant medications. Some tentative support for family involvement in the treatment of childhood anxieties and fears is reviewed, but clear conclusions await future investigations. Finally, several methodological limitations and needed areas of research are discussed.     

INTEGRATIVE PROBLEM-CENTERED THERAPY: TOWARD THE SYNTHESIS OF FAMILY AND INDIVIDUAL PSYCHOTHERAPIES*

Emerging from the growing trend toward integration in the field of psychotherapy, Integrative Problem-Centered Therapy (IPCT) provides a model for applying different modalities (individual and family) and orientations (behavioral, communicational and psychodynamic) to the broad range of problems patients bring to psychotherapy. Based on the assumption that each modality and orientation possesses its own domain of expertise, IPCT attempts to interrelate the major modalities and orientations to maximize their strengths and minimize their weaknesses. The goal is to create a maximally effective and efficient problem-centered psychotherapy. This paper presents an overview of IPCT, delineating its core principles and premises as well as the basic methodological steps in IPCT.     

Therapeutic alliance and treatment progress in couple psychotherapy

This study examined the ability of the therapeutic alliance to predict treatment progress on individual- and relationship-level variables from the early to middle phase of couple treatment. Although alliance did not predict progress in individual functioning, it accounted for 5-22% of the variance in improvement in marital distress. Women's mid-treatment alliance uniquely predicted improvement in marital distress, over and above early treatment alliance. When men's alliances with the therapist were stronger than their partners' at session 8, couples showed more improvement in marital distress. Treatment response was also positively associated with women's ratings of their partners' alliance. Results confirm that the therapeutic alliance in conjoint treatment is composed of distinct client subsystems that are useful predictors of treatment progress.     

The Multisystemic and Multilevel Investigation of the Expanded Therapeutic Alliance‐Psychological Functioning Relationship in Individual Therapy

The expanded therapeutic alliance, consisting of multiple interpersonal alliance relationships, is a common factor inherent to the practice of all systemic therapies. The following study has three specific aims: (a) Bring an expanded, multisystemic emphasis to the study of the therapeutic alliance in individual therapy; (b) Understand better the session‐by‐session relationship between alliance and psychological functioning, including distinguishing within‐person from between‐person variability by using multilevel modeling techniques; and (c) Explore the role of early attachment relationships and family‐of‐origin experiences in moderating the alliance‐psychological functioning relationship. Instead of taking only one or two alliance measurements throughout treatment like in the majority of previous research, we measured both alliance and psychological functioning continuously at each session for 296 subjects.     

THE INTEGRATIVE PSYCHOTHERAPY ALLIANCE: FAMILY,COUPLE AND INDIVIDUAL THERAPY SCALES*

The therapeutic alliance concept has been confined primarily to the literature on individual psychotherapy. This paper formally introduces the concept into the family and marital therapy domain and presents various clinical hypotheses about the nature of the alliance and its role in familyand marital therapy. A systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework. The implications of this integrative-alliance concept for family, couple and individual therapy research are examined. Three new system-ically oriented scales to measure the alliance in individual, couple and family therapy are presented along with some preliminary data on their methodological characteristics.