Integrative Families and Systems Treatment: a middle path toward integrating common and specific factors in evidence-based family therapy

A moderate common factors approach is proposed as a synthesis or middle path to integrate common and specific factors in evidence-based approaches to high-risk youth and families. The debate in family therapy between common and specific factors camps is reviewed and followed by suggestions from the literature for synthesis and creative flexibility in manual development. A preliminary integrative model termed Integrative Family and Systems Treatment is offered as one option in developing and testing a moderate common factors approach. Such a model might then be studied in eventual clinical trials with other well-developed evidence-based protocols to further address the common versus specific factor debate. Implications for further research and practice are offered.     

Decision theory,linear partial information and statistical dominance

The paper deals with decision making under conditions of linear partial information, i.e. when probabilities of states of nature are not known precisely, but are subject to linear constraints. Conditions ensuring strict and weak statistical dominance of one strategy over another are derived. It is also shown that weak dominance in terms of payoffs is equivalent to weak dominance in terms of regrets. The new results are more general than those obtained by Fishburn and by Kmietowicz and Pearman for weak and strict ranking of probabilities, and include them as special cases. The new results can be employed in practical decision making in several ways.     

Long-term low-dose dehydroepiandrosterone replacement therapy in aging males with partial androgen deficiency

Dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) age-related withdrawal is very likely to be involved in the aging process and the onset of age-related diseases, giving rise to the question of whether preventing or compensating the decline of these steroids may have endocrine and clinical benefits. The aim of the present trial was to evaluate the endocrine, neuroendocrine and clinical consequences of a long-term (1 year), low-dose (25?mg/day) replacement therapy in a group of aging men who presented the clinical characteristics of partial androgen deficiency (PADAM). Circulating DHEA, DHEAS, androstenedione, total testosterone and free testosterone, dihydrotestosterone (DHT), progesterone, 17-hydroxyprogesterone, allopregnanolone, estrone, estradiol, sex hormone binding globulin (SHBG), cortisol, follicle stimulating hormone (FSH), luteinizing hormone (LH), growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels were evaluated monthly to assess the endocrine effects of the therapy, while β-endorphin values were used as a marker of the neuroendocrine effects. A Kupperman questionnaire was performed to evaluate the subjective symptoms before and after treatment.

The results showed a great modification of the endocrine profile; with the exception of cortisol levels, which remained unchanged, DHEA, DHEAS, androstenedione, total and free testosterone, DHT, progesterone, 17-hydroxyprogesterone, estrone, estradiol, GH, IGF-1 and β-endorphin levels increased significantly with respect to baseline values, while FSH, LH and SHBG levels showed a significant decrease. The Kupperman score indicated a progressive improvement in mood, fatigue and joint pain.

In conclusion, the present study demonstrates that 25?mg/day of DHEA is able to cause significant changes in the hormonal profile and clinical symptoms and can counteract the age-related decline of endocrine and neuroendocrine functions. Restoring DHEA levels to young adult values seems to benefit the age-related decline in physiological functions but, however promising, placebo-controlled trials are required to confirm these preliminary results.     

ETHICS AND STRATEGIC THERAPY: A PROPOSED ETHICAL DIRECTION

Although ethical criticisms have been leveled against strategic therapy for some time, the current intensification of such criticisms indicates the need for continued dialogue about ethical strategic practice. This article presents ethical directions in two broad areas often seen as inherent in the strategic approach: (a) conscious deception and (b) intervention outside client awareness. Emerging from a discussion of the clinical implications of a constructivist view and a meaning system vocabulary of client change, five ethical presuppositions are exemplified. The ethical concerns of manipulation, power, and control are also discussed.     

STRATEGIC-BRIEF THERAPY: AN INSIGHT-ORIENTED APPROACH?*

The role and importance of insight to the change process has been debated for many years. Strategists have given a significant amount of attention to discrediting insight and in the process have not considered its strategic advantages. This article will clarify the role of insight in strategic therapy and make distinctions between therapist-ascribed meaning (reframing) and interpretation, as well as client-ascribed meaning and insight. It will be argued that insight-oriented and strategic therapists share much in common and that insight, perhaps contrary to the current view, indeed has a role in the practice of strategic therapy.