The TIP presents the models, techniques and principles of family therapy, with special attention to the stages of motivation as well as to treatment and recovery. Since moderation analysis could only be performed with a minimum of five studies, we were unable to test the models in which the family therapeutic interventions were based as a moderator for the two treatment studies. and here. As originally hypothesized, our analysis of level of family involvement showed that mothers of family members who attended at least 80% of the preventive intervention sessions experienced a statistically significant decrease in depressive symptoms when compared to those of family members who attended fewer sessions. Systemic family therapy, as well as focal psychotherapy, was significantly superior to the control treatment. For these reasons, many professional organizations (e.g., American College of Obstetrics and Gynecology, American Academy of Pediatrics) have recommended the use of depression screening measures in primary care settings and raised awareness of the need for treatment. Given that around 30% of adults with depression seek psychotherapy [62] and less than 30% of women who screen positive for perinatal depression attend a mental health visit (for psychotherapy or psychiatric medication) [63–65] with approximately 6% completing treatment in the United States [63,65], we suspect that a lower percentage of women with perinatal depression seek family therapy for two reasons. Despland, Jean-Nicolas Roles This allows the formulation of concrete interventions. The guidelines established by the Cochrane Handbook for Systematic Reviews of Interventions [50] were used in our rigorous evaluation of the included studies and our meta-analysis. Other studies (Reference MartinMartin, 1985; Reference Herscovici and BayHerscovici & Bay, 1996) have replicated these results, with systemic family therapy being the main treatment, although used in combination with a mixture of individual and in-patient treatments. Prabhu, Sheila Lobo Evaluation of the impact on relatives and patients, The treatment and outcome of anorexia nervosa in adolescents: a prospective study and five year follow-up, Behavioural family treatment for patients with bipolar affective disorder, Psychosomatic Families: Anorexia Nervosa in Context, Marital therapy: a viable treatment for depression and marital discord, Family intervention for schizophrenia (Cochrane Review), A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa, Journal of the American Academy of Child & Adolescent Psychiatry, An evaluation of family therapy in anorexia nervosa and bulimia nervosa, Evidence based medicine: what it is and what it isn't, Handbook of Psychotherapy for Anorexia Nervosa and Bulimia, Paradox and Counterparadox: A New Model in the Therapy of the Family in Schizophrenic Transaction, Hypothesizing-circularity-neutrality; three guidelines for the conductor of the session, The effectiveness of behavioural parent training to modify antisocial behaviour in children: a meta-analysis, The effects of family and marital psychotherapies: a meta-analysis, Family therapy and soiling: an audit of externalising and other approaches, Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads, Outcome, attrition and family-couples treatment for drug abuse: a meta-analysis and review of the controlled comparative studies, Caring for relatives with serious mental illness: the development of Experience of Caregiving Inventory, Social Psychiatry and Psychiatric Epidemiology, The community management of schizophrenia: a controlled trial of behavioural intervention with families to reduce relapse, The measurement of expressed emotion in families of psychiatric patients, British Journal of Social and Clinical Psychology, Adolescent substance abuse and family therapy outcome: a review of randomised trials, Change: Principles of Problem Formation and Problem Resolution, The Measurement and Classification of Psychiatric Symptoms, Family-based intervention for schizophrenic patients in China. The protocol for the current systematic review and meta-analysis is registered with PROSPERO (CRD42017075150). The review assumes that the common aim of each of … The approach is based on the observation that symptoms and problems have a tendency to fluctuate. No, Is the Subject Area "Mental health therapies" applicable to this article? https://doi.org/10.1371/journal.pone.0198730.g004. by Leon Rosenberg When do we shift from trying to work within the parent-child relationship to seeing the child as a separate entity needing to cope with a destructive parent? In summary, these findings show that systemic therapy can make a useful contribution in the treatment of adult with anorexia, but more research needs to be undertaken to further strengthen the emerging evidence base for systemic therapy with this age group. 2007. von Sydow, Kirsten Research has shown that family therapeutic interventions that aim to prevent or reduce perinatal depression target communication skills related to expectations (including those that pertain to gender roles and the transition to parenthood) and emotional support [34–40], conflict management [38–39], and problem-solving skills related to shared responsibility in infant care and household activities [36–39]. 1. There were also some apparent differences between the patient groups in that the patients in the Maudsley studies tended to have a longer duration of illness, the majority had had previous treatments and a higher percentage were suffering from depression. PLoS ONE 13(6): The evidence for the effectiveness of systemic therapy for adolescent anorexia nervosa is reasonably compelling as several reviewers have recently concluded (e.g. Approximately two-thirds of the patients with eating disorders were still at school, with the others being either at university or working. Many of the most popular models during the period when family therapy flourished in the 1960s and 1970s directly incorporated systems theory. The findings for the biases by which the seven studies were judged are summarized in the following six subsections. https://doi.org/10.1371/journal.pone.0198730.g003. Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America, Furthermore, there is evidence that there is a tendency to improved compliance with medication for individuals whose relatives receive family intervention, suggesting that family intervention does encourage drug compliance. Following an overview of the theoretical foundations undergirding this therapeutic approach, a case study is used to illustrate the use of numerous NFT techniques. Strategic systemic therapy (Reference HaleyHaley, 1963; Reference Watzlawick, Weakland and FischWatzlawick et al, 1974) is based on the hypothesis that the symptom is being maintained by behaviours that seek to suppress it. A further difference concerns the length of treatment, which was 6 months in the Le Grange et al (1992), 12 months in the Eisler et al (2000) and 12–18 months (with an average of 16 months) in the Robin et al (1999) studies. Earn 1.0 CE Credits Lynn Ponton on the Challenges and Joys of Working with Teens . Patients had to meet criteria for depression as measured by the Present State Examination (Reference Wing, Cooper and SartoriusWing et al, 1974), Hamilton Depression Rating Scale (Reference HamiltonHamilton, 1960) and the Beck Depression Inventory (BDI) (Reference Beck, Ward and MendelsonBeck et al, 1961). Published online by Cambridge University Press:  The I2 statistic was used to assess heterogeneity between studies. https://doi.org/10.1371/journal.pone.0198730.t001. 3. Some thoughts with regard to training will be offered. and Type V evidence (expert opinion, including the opinion of service users and carers) is mounting, in line with increased user involvement in the running of mental health services. Family therapy interventions aim to change family dynamics, such as those mentioned in the above paragraph. This systematic review and meta-analysis is a synthesis of the current evidence on the usefulness of family therapy interventions in the prevention and treatment of perinatal depression and impacts on maternal depressive symptoms and family functioning. Using the criteria for levels of evidence, as outlined in the National Service Framework, there is Type I evidence (at least one good systematic review, including at least one randomised controlled trial (RCT)) for a number of conditions and presentations (e.g. Research on couples and couple therapy: what do we know? For this reason, this finding should be interpreted with caution. Experimental intervention groups were compared to control groups comprised of standard care, treatment as usual, wait-listed, or no care conditions. Level of family involvement was dichotomized using the mean percentage of sessions attended by family members (79% or fewer sessions = 2 studies; 80% of sessions or more = 3 studies). Second, the content expert independently reviewed full-text articles. While there were no significant differences in outcome between treatments for the group as a whole, in the subgroup of patients with a first episode of anorexia nervosa in adulthood (n = 14), the results favoured individual therapy, with a significantly greater weight gain. At the more severe end of the spectrum, family interventions, in addition to ongoing traditional treatments, have been found to significantly reduce relapse rates of patients suffering from bipolar disorder (Reference Miklowitz and GoldsteinMiklowitz & Goldstein, 1990), confirming similar findings by Clarkin et al (1990). Retzlaff, Rüdiger The studies used a large number of outcome scales with the following being regarded as most relevant: Brief Psychiatric Rating Scale (Reference Overall and GorhamOverall & Gorham, 1962); Camberwell Family Interview (Reference Vaughn and LeffVaughn & Leff, 1976); Experience of Caregiving Inventory (Reference Szmukler, Burgess and HerrmanSzmukler et al, 1996); Global Assessment Scale (Reference Endicott, Spitzer and FleissEndicott et al, 1976); Present State Examination (Reference Wing, Cooper and SartoriusWing et al, 1974); and Ways of Coping (Reference MacCarthy, Kuipers and HurryMacCarthy et al, 1989). Structural family therapists intervene with the aim of making the family structure approximate this normative model. In the treatment of anorexia nervosa systemic family therapy is: a the only effective treatment for adults, b the treatment of choice for adolescents, c particularly effective with early-onset anorexia, d a quick symptomatic relief but with no long-lasting effects. Family Therapy for Substance Use among Sexual Minority Youth: A Review of Treatment Options. Brief review of major systemic therapy approaches, Evidence for the effectiveness of systemic therapy for eating disorder, Systemic family and couple therapy for mood disorders, Reference Gustafsson, Kjellman and Cederbald, Reference Silver, Williams and Worthington, Reference Wilson, Fairburn, Nathan and Gorman, Reference Tarrier, Barrowclough and Vaughn, Reference Emanuels-Zuurveen and Emmelkamp, Reference Klerman, Weissman and Rounsaville, A psychoeducational program for families of patients with schizophrenia, Family therapy outcome research: a trial for families, therapists and researchers, Empirically supported couple and family interventions for marital distress and adult mental health problems, Journal of Consulting and Clinical Psychology, Milan Systemic Family Therapy: Theoretical and Practical Aspects, Influence of family life on the course of schizophrenic disorders: a replication, Evidence-based practice in family therapy and systemic consultation I, Evidence-based practice in family therapy and systemic consultation II, A randomised clinical trial of inpatient family intervention, V. Results for affective disorders, A controlled study of the effect of therapies aimed at adolescent and family psychopathology in anorexia nervosa, Chronic eating disorders in therapy: clinical stories using family systems and psychoanalytic approaches, Psychological therapies for adults with anorexia nervosa: a randomised controlled trial of out-patient treatments, Family therapy for bulimia nervosa in adolescents: an exploratory study, Meta-analytic review of marital therapy outcome research, Family therapy treatment outcomes for alcoholism, Family and individual therapy in anorexia nervosa. Conditions with evidence of response to systemic therapy. At the end of 1-year follow-up, the group of patients as a whole showed modest symptomatic improvements. Overall, we found statistically significant reductions in perinatal depressive symptoms for mothers who participated in indicated preventive and treatment interventions. The concept of family homeostasis and related concepts such as family rules and family feedback mechanisms came under heavy fire in a recent article by … Depressive symptoms develop anytime during pregnancy or within the first year after childbirth [1]. General Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America, Roles All types of intervention intensity (e.g., universal, selective and indicated prevention, treatment) were included in our searches. Case illustrations will then be used to show how the supervisor of a family treatment case elicited the countertransference in order to move the therapy forward. A random effects model revealed significant associations for mothers who participated in an indicated preventive intervention (SMD = -0.373, 95% CI = -0.725, -0.020; z = 2.07, p = 0.04) and those who participated in treatment (SMD = -0.523, 95% CI = -1.045, -0.002; z = 1.97, p = 0.05) when compared to those who participated in universal prevention interventions (SMD = -0.093, 95% CI = -0.253, 0.068; z = 1.13, p = 0.26). COFT appreciates a multidisciplinary approach, and welcomes manuscripts which address processes … The studies that met inclusion criteria included systemic interventions applied to both parents/primary caregivers who were either expecting a baby or who had at least one infant. The remaining studies enrolled mothers within six months of the birth of the baby. Descriptive articles address current issues, innovative methods, and professional concerns. We used stratified analysis for study quality to assess discrepancies in results that were based on bias. Being at the receiving end of family therapy can have strong connotations of blame. Family therapy is based in systems theory, which generally focuses on the ways in which family interactions affect each individual family member’s functioning and affect the family’s overall functioning [29–30]. The means and standard deviations were standardized using Stata 15.1 [58]. The likelihood of type one and type two errors increases as more subgroup analyses are performed [59] and for this reason, subgroup analyses were only conducted on a minimum of five studies to determine if hypothesized moderators strengthened intervention impacts on outcomes. Different phases of therapy require different techniques, styles and positions of the therapist and different working contexts clearly require different responses to the patients and the problems they and their families present. Two treatment studies and five prevention studies were included in the meta-analysis. Copyright © The Royal College of Psychiatrists 2002, Hostname: page-component-546c57c664-gj7tc Patients allocated to one of the treatments were not permitted to receive any other treatment simultaneously. Evidence-based medicine (Reference Sackett, Rosenberg and GraySackett et al, 1996) emphasises that appropriate treatments need to be matched with specific conditions, with outcomes being scientifically evaluated. As shown in Table 1, most of the studies included interventions that are based in cognitive-behavioral couple therapy. We use cookies to distinguish you from other users and to provide you with a better experience on our websites. The Cochrane review focused primarily on the following outcomes: suicide, relapse and hospital admission. However, it is possible that the inclusion of more studies could produce a significant result. Earn 1.0 CE Credits Lynn Ponton on the Challenges and Joys of Working with Teens. The family and therapy The term family therapy can be misleading. One study used a psychoeducational model where partners were educated on perinatal depression and positive dyadic interaction was encouraged [49]. Looking at the various studies, it transpires that there was no universally accepted definition of relapse. Family counselors eagerly extoll the benefits of family therapy and even encourage counselors who work with individual clients to consider the family environment. Nonetheless, this finding should be interpreted with caution since we were only able to include five prevention studies in this analysis. A wealth of data is now available and much of these are well summarised by Carr (2000a,b). 2010. Systemic ideas offer a unique contribution at the psychotherapeutic and psychiatric interface. The remaining study [36] was judged as unclear because there was insufficient evidence that the lack of blinding of participants influenced the outcomes. The searches returned articles published between 1995 and 2017. Two moderators were explored in the five prevention studies: dosage and level of family involvement. and Eckert, J. The purpose of the current study is to evaluate the existing evidence on the effectiveness of family therapeutic interventions in reducing perinatal depressive symptoms and improving family functioning. We defined family therapy interventions as those that addressed relationship dynamics to create changes in relational functioning. 2010. Retzlaff, Rüdiger These results, combined with its well-described theoretical model, have made the work of the Philadelphia team highly influential, despite the study's methodological problems (no comparison treatment, no independent research team, very varied length of follow-up). The primary outcome was maternal depressive symptoms, and studies that measured change in maternal depressive symptoms from baseline to at least one post-intervention time point were included. The current study shares four similar methods with the previously published systematic reviews and meta-analyses. Third, we conduct separate analyses for treatment and prevention studies using data analytic strategies that are similar to those in other published reviews [11,43]. The search strategy used for PubMed is included, below. Project administration, No, Is the Subject Area "Human families" applicable to this article? Despland, Jean-Nicolas Oakley, Clare Furthermore, future research should include interventions that target the mother (pregnant and post-delivery) and her extended family members (e.g., grandparents, next of kin, adult siblings, etc.). A recent RCT (Reference Leff, Vearnals and WolffLeff et al, 2000) has confirmed the efficacy of systemic couple therapy with people with depression living with a partner. By contrast, the Maudsley studies allowed for admission only if out-patient therapy had failed to arrest weight loss (none of the 18 patients in Le Grange et al's study and 4 out of 40 in Eisler et al's trial were admitted during the study). Effects of substance use disorders on the family. Overall, 86% of studies [34–35, 37–39, 40] had a low risk of performance bias because either study participants could not be blinded given the nature of the intervention or only research personnel were blinded as it was not feasible to blind interventionists. Family intervention had no effect on the number of individuals who killed themselves during the follow-up periods of the studies. Overall, we found a statistically significant reduction in maternal depressive symptoms from baseline to the first follow up time point (SMD = -0.178, 95% CI = -0.317, -0.039; z = 2.51, p = .01; I2 = 1.1%). “Family therapy isn’t just a new set of techniques. Examples of family therapeutic interventions include: behavioral marital therapy, cognitive-behavioral skills training (e.g., couple communication, problem-solving, conflict management), interpersonal therapy, and solution-focused therapy. Bias in cluster randomized trials was assessed using additional criteria: 1) recruitment bias as it pertains to the randomization of all study sites at the same time; 2) baseline imbalance as it applies to the stratification or pair-matched randomization of sites; 3) explanations as to why any study sites were excluded from the analysis; 4) incorrect analysis; and 5) comparability with traditional RCTs [54]. "metricsAbstractViews": false, Marital therapy as a treatment for depression, Emotionally focused family therapy for bulimia: changing attachment patterns, Psychosocial treatments for conduct disorder in children, Family Work for Schizophrenia: A Practical Guide, Childhood asthma: a controlled trial of family psychotherapy, A controlled trial of social intervention in schizophrenic families, The London Depression Intervention Trial. Schweitzer-Rothers, Jochen Since there was limited variability in demographic characteristics, subgroup analyses were not conducted for the primary outcomes. Second, barriers may create difficulties in delivering and receiving these family therapeutic in real world settings. The results are fairly impressive, but no distinction is made between adolescents and adults. Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views. Lomax, James The most recent Cochrane review (Pharaoh et al, 2000) found that 13 studies met its inclusion criteria (out of 69 citations). In brief solution-focused therapy (Reference De ShazerDe Shazer, 1985) the problem saturated ways of talking are deliberately ignored, with the focus instead on the patterns of previous attempted solutions. This data will be updated every 24 hours. SCHWEITZER, JOCHEN Concrete goals for change are targeted by both family and therapist, following an analysis of the observed or recounted family and couple interactions. First, the interventions examined by us and others [10–11, 13, 41–43, 46] primarily focus on preventive psychosocial interventions or psychosocial treatments that aim to reduce perinatal depressive symptoms. Several studies have also shown that marital/relationship dissatisfaction is associated with perinatal depression [16–17, 25–28]. New epigenetic research is included suggesting that nurturing parenting significantly prevents the phenotypic expression of inherited genetic diseases including substance abuse. In summary, our study will enhance the existing knowledge on effective family-based psychotherapeutic interventions for the prevention and treatment of perinatal depression. Finally, the quality ratings for the seven included studies ranged from moderate to high. To date, there is only one randomised trial of systemic therapy in bulimia nervosa, the Russell et al (1987) study described earlier, which included a subgroup of 23 adult patients with bulimia nervosa. Systemic family and couple therapy has also been shown to be effective in the treatment of eating disorders, psychotic illnesses and mood disorders. If the baseline and follow-up outcome measures are correlated, then we most likely underestimated the significant effects of the intervention impacts on maternal depressive symptoms and family functioning. The purpose of this article is to chronicle the theoretical developments and clinical trends that have emerged in the profession of marriage and family therapy in recent years, an historical period so marked by transition and new ways of seeing the world that the popular press has dubbed it the Postmodern era. Yes Conceptualization, One difference was that Robin and his team hospitalised patients whose weight was below 75% of ideal weight (43% of their sample) at the start of the treatment programme until their weight rose above 80% (of ideal weight). Samantha K. J. Simpson, Jared M. Hawkins & Roy A Bean. https://doi.org/10.1371/journal.pone.0198730, Editor: Qinhong Zhang, Stanford University School of Medicine, UNITED STATES, Received: December 16, 2017; Accepted: May 24, 2018; Published: June 14, 2018. The intent of this article is to describe the importance of one psychoanalytic concept, countertransference, in family treatment by a review of the literature on the subject. The limited number of included studies represents the few high quality controlled trials that have been conducted with this vulnerable population. This important finding has led to a number of interventions aimed at reducing expressed emotion levels. Thus, the lack of available qualified providers may limit dissemination of these types of interventions. A 5-year follow-up, Family therapy for adolescent anorexia nervosa: the results of a controlled comparison of two family interventions, Journal of Child Psychology and Psychiatry, Behavioural family therapy: systems, structures and strategies, Treatment of Depression: An Interpersonal Systems Approach, Family therapy in the treatment of severe childhood asthma, Brief psychotherapy in the treatment of anorexia nervosa. Boillat, Camille Google Scholar provides a simple way to broadly search for scholarly literature. No eLetters have been published for this article. It is important to recognise, however, that this may be, at least in part, owing to the lack of research on other treatments for this condition. and This model of therapy focuses on challenging thoughts that interfere with healthy communication and problem-solving and teaching couples specific skills to improve communication, reduce conflict, and increase shared problem-solving [61]. THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / January 2003Magnuson, Shaw / ADAPTATIONS OF THE GENOGRAM Article Literature Review—Practice Adaptations of the Multifaceted Genogram in Counseling, Training, and Supervision Sandy Magnuson Holly E. Shaw University of Northern Colorado This article provides a review of representative literature … For Other bias, all seven studies (100%) were judged as low risk of bias. The searches included publication date restrictions and an English language restriction. broad scope, and wide readership – a perfect fit for your research every time. Once some progress has been made, the focus shifts to the expression of negative feelings in a constructive manner so that problem resolution can be facilitated. Reference Garner, Last and HersenGarner, 1994; Reference Fishman and WerneFishman, 1996; Reference DareDare, 1997; Reference Johnson, Maddeaux and BlouinJohnson et al, 1998), there is at present little convincing evidence for its efficacy. It is very likely that different subgroups respond differently to particular treatments. 2. Two evaluators (first and second authors) rated each included study on each criterion. "hasAccess": "1", Family intervention with people with schizophrenia is particularly effective if: a the patient fully understands all the concerns his/her relatives have about him/her, b the family gets much more involved with the ill member, c carers exchange their experiences and ideas, d the patient is asked to be less critical of his/ her carers. We determined that one cluster randomized trial and one randomized controlled trial (n = two prevention studies) could not be included in the analysis for the family functioning outcome because the measures could either not be standardized or the outcome was measured at time points that did not align with the measurement points in the other included studies. We also excluded one treatment study that was a randomized controlled trial from this analysis because the family functioning measure was only administered to mothers and not their family members. JMFT is a peer-reviewed journal that advances the professional understanding of marital and family functioning and the most effective psychotherapeutic treatment of couple and family distress. All primary outcomes were continuous. Communication training, for example, is a behavioural intervention strategy with an initial emphasis on clear and direct expression of positive feelings, ideas and plans. Dosage was measured by number of sessions and intervention duration in hours in the prevention studies (six or more sessions totaling at least 12 hours = 3 studies; five or fewer sessions under 12 hours = 2 studies). All studies were published in peer-reviewed journals. For more information about PLOS Subject Areas, click Standard deviations were pooled using a very conservative formula that assumed the baseline and post-intervention measures were not correlated since these were not reported in the included studies [49]. Was evaluated at the receiving end of treatment and again after a period of no treatment lasting 12–15 months participated! The seven key modalities in considerable detail in the meta-analysis study [ 38 was! Members improve communication to strengthen parenting [ 37–38,40 ] about PLOS Subject Areas, click here systemic! Still at school, with an unusually long 2-year follow-up, is Subject. 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