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Family Therapy (Family Focused Therapy)

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Introduction to family therapy 

Family therapyFamily therapy, sometimes called family focus therapy or family systems therapy, is a type of psychological therapy that works to change the relationships within families to help them better deal with a wide range of problems.

Family therapy helps family members find constructive ways to help each other. Due to this flexibility, family therapy is useful in a wide range of situations. Family therapy can be useful in childhood and adult conditions including conduct and mood disorders, eating disorders, drug abuse and psychiatric conditions as well as couples experiencing difficulties. Family therapy is useful throughout life and can be especially useful in the treatment of long term illness such as depression.

Family therapy usually works within family groups but often includes work with people on an individual basis or, when appropriate, individual sessions within a series of family meetings. Family therapy may also include the social networks around families.  


What is family therapy?

Family therapy is a possible treatment for a number of conditions including serious psychiatric illnesses such as depression and schizophrenia. Family therapy is based on two principles:

  • Many illnesses are made worse by a dysfunctional family
  • Close family relationships are often the most important supports a person has, and therefore are extremely important in any long term treatments

Family therapy can be defined as any psychological treatment that focuses on:

  • Changing the way family members interact
  • Improving the functioning of the family as a unit
  • Improving the functioning of individuals in the family


How does family therapy work?

There are several types of family therapy which can often be used in together. These include:

  • Psycho education: This focuses on teaching a family about an illness to change any negative (and possibly false) ideas that family members may have about the illness.
  • Teaching coping skills
  • Behavioural models: These work on teaching parents about positive and negative reinforcement to help parents with difficult child behaviour.
  • Systemic models: These consider that dysfunctional family relationships often worsen an illness and therefore improving family relationships will improve symptoms.
  • Structural family therapy: This focuses on restoring proper family structure and organisation.
  • Post-Milan family therapy: This focuses on communication between family members.
  • Solution focused therapy: This focuses on identifying each family member’s strengths and then using these strengths to help solve problems.

These are just some of the different strategies that can be used during family therapy to help overcome any problems that a family, or family member, may be experiencing.


What is involved in family therapy?

Family therapy is not a quick and easy solution and requires time and effort to work well. Families undertaking family therapy must realise that family therapy involves both formal sessions and homework, where the newly learned skills and techniques must be put into practice, all day, every day. The number of formal sessions varies considerably depending on the illness and family dynamics. Usually between 5 and 20 sessions are required. Sessions usually involve a family therapist meeting several members of the family at the same time (this allows any problems between family members to be resolved directly and allows the therapist to accurately assess the family). There are also often individual sessions and possibly sessions involving the wider family or other significant friends. 


Effectiveness of family therapy

Family therapyFamily therapy has been shown to be of use in a number of different conditions. There is good evidence that family therapy is very useful in the following childhood and adolescent conditions:

In adults, family therapy has been shown to be useful in:


Schizophrenia

Patients with schizophrenia often come from family groups that have high levels of hostility or criticism. Because of this, family therapy has for a long time been suggested as a possible treatment for schizophrenia.

There is now extensive evidence for the use of family therapy in schizophrenia. The first studies to show that family therapy was useful in schizophrenia where published in the 1970s and from this time there has been a lot of research into the use of family therapy for schizophrenia. The different types of family therapy that have been used include the more traditional psycho-education component and communication improvement as well as more novel approaches including motivational interviewing, crisis handling therapy and even relaxation therapy. The number and type of family therapy sessions required vary depending on the particular person and family

The results of a mayor review of the research found that family therapy did reduce the symptoms and and may also reduce the number of times that a patient had to be placed into hospital. Family therapy was also useful in reducing the isolation and the social withdrawal that many people who suffer from schizophrenia experience. Another benefit of family therapy is that people who receive family therapy often take their medications more regularly and as a result have fewer symptoms and a better quality of life.

SchizophreniaFor more information on schizophrenia and its treatments, and some useful tools, animations and videos, see Schizophrenia


Depression

Family therapy is often used in depression. Numerous different types of family therapy have been investigated for the treatment of depression and while there is still some disagreement about how useful family therapy is for depression. Family therapy has been shown to be very useful in some patients the evidence is not as solid as for other forms of psychological therapy, especially cognitive behavioural therapy.

An important topic to also consider is the use of family therapy in children and adolescences with depression. A recent study looked at children with depression and offered these children a family therapy program of 12 to 16 1 hour sessions over a 5 month period. The family therapy focused on communication and problem solving skills and included education and role playing to practice new skills. The results were that two thirds of the children and adolescents had recovered from their depression when the program finished and that three quarters had recovered 9 months after the treatment. This demonstrated that although there many be doubt about the use of family therapy in adults it is a very good treatment for children and adolescents with depression.


Bipolar disorder

Family therapy for bipolar disorder has been used for many years as an addition to medications. The main types of family therapy that are used include psycho education, family cognitive behavioural therapy and communication therapy (such as the post-Milan type therapy). However, despite its long term use there is not much evidence for the use of family therapy in bipolar disorder. Research has shown only small improvements in symptoms in the short term and no real improvements in the long term (in terms of months and years). More research is needed to provide the answers about the use family therapy in bipolar disorder.


Anorexia nervosa

There is good research about the use of family therapy in anorexia nervosa. Originally, family therapy was shown to be useful in people who had very bad anorexia and needed to be placed in hospital to have their weight restored. In these people family therapy was shown to be useful in helping keep a healthy weight after they left hospital. There has now been more work done that shows that family therapy is also very useful in people with less severe anorexia. In these people family therapy can result in quick weight gain and more importantly help keep the weight stable in the long term (up to 5 years have been looked at and many people still had stable weight). Unlike the very time consuming and restrictive treatments of anorexia that often need the person to stay in hospital for a long period of time family therapy can be run (with the person at home) as a series of about 20 sessions over the course of a year.

Family therapy is useful for both adolescences and adults with anorexia nervosa. For adolescents family therapy encourages the parents to take control of the adolescent’s eating. An example is a 3 stage program. In Stage 1 the parents (and siblings) are tasked with restoring the adolescent’s weight. In stage 2 the parents gradually give the adolescent control over eating. Stage 3 finishes the program by addressing the broader concerns of the adolescent (such as body image issues). Although such a program may seem very difficult research shows that such programs are generally well received by the families and often have very good outcomes in maintaining healthy body weight.


Cost of family therapy

While there is good evidence that family therapy is a very useful tool many people are concerned about the high cost of family therapy. However, this was recently analysed and it was found that family therapy can actually significantly reduce healthcare costs. This is because if the family therapy is helps then the person (and their family) will use less healthcare services (such as doctor’s appointments, medications, etc) and there will be an overall saving, both to the family and the wider community.

More information

ParentingFor more information on various aspects of parenting, see Parenting.

 

References

  1. Cottrell D, Boston P. Practitioner review: the effectiveness of systemic family therapy for children and adolescents. Journal of Child Psychology and Psychiatry 2002;43(5):573–86.
  2. Henken HT, Huibers MJH, Churchill R, Restifo K, Roelofs J. Family therapy for depression. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD006728.
  3. Sprenkle D, Bischof G. Contemporary family therapy in the United States. Journal of Family Therapy 1994; 16(1): 5-23.
  4. Stratton, P. Report On The Evidence Base Of Systemic Family Therapy. Association for Family Therapy 2005.
  5. Murphy K. Treatment Strategies for a Case of Severe ADHD. J Atten Disord 2007; 11; 407
  6. Griswold K, Aronoff H, Kernan J, Kahn L. Adolescent Substance Use and Abuse: Recognition and Management. Am Fam Physician. 2008;77(3):331-336.
  7. Carr Evidence-Based Practice in Family Therapy and Systemic Consultation I: Child focused problems. Journal of Family Therapy 2000; 22: 29-60.
  8. Asen, E. Outcome research in family therapy. Advances in Psychiatric Treatment 2002;  8: 230-8.
  9. Pharoah F, Mari J, Rathbone J, Wong W. Family intervention for schizophrenia. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD000088.
  10. Bressi C, Manenti S, Frongia P, Porcellana M, Invernizzi G. Systemic Family Therapy in
    Schizophrenia: A Randomized Clinical Trial of Effectiveness. Psychother Psychosom 2008;77:43–49
  11. Thompson M, Pierre C, Haber F, Fogler J etal. Family-focused Treatment for Childhood-onset Depressive Disorders: Results of an Open Trial. Clinical Child Psychology and Psychiatry Copyright 2007;  12(3): 403–20.
  12. Justo LP, Soares BGO, Calil HM. Family interventions for bipolar disorder. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005167.
  13. Loeb K, Walsh T, Lock J, Le Grange D etal. Open Trial of Family-Based Treatment for Full and Partial Anorexia Nervosa in Adolescence: Evidence of Successful Dissemination. American Academy of Child and Adolescent Psychiatry 2007; 46(7): 792-800.
  14. Crane D. Research on the Cost of Providing Family Therapy: A Summary and Progress Report. Clinical Child Psychology and Psychiatry Copyright 2007; 12(2): 313–320.

Dates

Posted On: 8 April, 2008
Modified On: 19 March, 2014

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