Family Therapy

Question 1

Underlying Theory

Answer 1

• Works with families and couples in intimate relationships to nurture change and development
• Views change in terms of the systems of interaction between family members
• Emphasises family relationships as an important factor to psychological health

Question 2

Techniques and Strategies

Answer 2

Family therapy uses a range of counseling and other techniques including:

Structural therapy - Identifies and Re-Orders the organisation of the family systemStrategic therapy

• Looks at patterns of interactions between family membersSystemic/Milan therapy
• Focuses on belief systems

Narrative Therapy
- Restoring of dominant problem-saturated narrative, emphasis on context, separation of the problem from the person

Transgenerational Therapy
 - Transgenerational transmission of unhelpful patterns of belief and behaviour.
•	communication theory
•	media and communications psychology
•	psychoeducation
•	psychotherapy
•	relationship counseling
•	relationship education
•	systemic coaching
•	systems theory
•	reality therapy
•	attachment-focused family therapy
•	the genogram

Question 3

Applications

Answer 3

• Enables family members, couples and others to express and explore difficult thoughts and emotions safely

Question 4

Evidence base

Answer 4

Carr (2009a) concludes that evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for:
• sleep, feeding and attachment
• problems in infancy;
• child abuse and neglect;
• conduct problems . including:
• childhood behavioural difficulties,
• attention and overactivity (ADHD),
• delinquency and drug abuse;
• emotional problems (including anxiety, depression, grief, bipolar disorder and suicidality);
• eating disorders (including anorexia, bulimia and obesity); somatic problems (including enuresis, encopresis, recurrent abdominal pain, and poorly controlled asthma and diabetes).

• For example Cottrell and Boston (2002) concluded that family interventions are effective for:
  Conduct disorders;
  Substance misuse; and
  Eating disorders; and as a second-line treatment for depression and chronic illness.
• Asen (2002), from a more selective review, also concludes that there is strong evidence for using
  Family Therapy with conduct problems of children and eating problems in adolescence.

Family therapy with adults

Sydow et al.2010 report specifically on systemic therapy for ‘mental disorders’ rather than the broad definition of family therapy and systemic interventions adopted by Carr (2009b) .

Their meta-content analysis of RCTs published in English, German, Spanish, and Chinese found that systemic therapy was efficacious for the treatment of:
• mood disorders,
• eating disorders,
• substance use disorders,
• mental and social factors related to medical conditions and physical disorders,
• schizophrenia.

Systemic therapy may also be efficacious for anxiety disordersIn the second of his linked articles, reviewing therapy with adults,

Carr (2009b) found good support for Family Therapy in the following range:
•	 relationship distress,
•	psychosexual problems,
•	 domestic violence,
•	 anxiety disorders,
•	 mood disorders,
•	 alcohol abuse,
•	 schizophrenia,
•	adjustment to chronic physical illness.

Question 5

Family therapy for Bi polar disorder

Answer 5

Mahli et al (2009)

• family therapy has level 2 evidence base

Question 6

Family therapy for anorexia

Answer 6

Bulik et al (2007)

• no supported evidence for efficacy for anoxeria

                       Dare et al (2001)

• participants in family therapy showed significantly greater improvements

Question 7

Family therpy for schizophrenia

Answer 7

NICE (2009)

• Family intervention appears to be an efficacious treatment for schizophrenia

Question 8

Family therapy for depression

Answer 8

David-Ferdon et al (2008)

• compared to CBT and IPT, family therapy shows little effectiveness in childhood schizophrenia

                         Henken et al (2007)

• family therapy superior to waitlist or no treatment control
• compared to other interventions for depression family therapy showed less effectiveness

Question 9

Family therapy for problematic substance abuse

Answer 9

Vaughn (2004)

• Group CBT and family therapy have high levels of evidentiary support

                             Liddle (2004)

• family based interventions lead to significant reductions in alcohol and drug use related problems such as family conflict and delinquency

                          Slesnick et al (2009)

• family therapy approaches significantly reduce alcohol and drug use compared to TAU at 15 month follow up,
• lower treatment refusal and higher treatment retention rates
• improved psychological functioning in all conditions