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The Handbook of Systemic Family Therapy
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Showing Rating details. All Languages. More filters. Sort order. Michael Morgan rated it really liked it Aug 25, Eve rated it it was amazing Sep 09, Glenn rated it really liked it Sep 14, Marzena Mlyniec rated it liked it Jan 21, Mark Goodman rated it it was amazing Mar 17, Julie rated it liked it Dec 10, Aron rated it liked it Nov 05, Danielle rated it did not like it Aug 02, Alicia Cybulski rated it liked it Jun 07, Frank Spencer added it Apr 22, Sheina marked it as to-read Mar 05, Julius Gilliard marked it as to-read Mar 08, Bobbie marked it as to-read Jul 13, The goal of the present study was to evaluate the efficacy of specific systemic family therapy approaches in families with an adolescent presenting a mental health problem.
From a systemic perspective, family is defined as a transactional system, where difficulties in any member have an influence on every other member and on the whole family as a unit. In turn, family processes have an impact on every individual member, as well as on the different relationships embedded within the family context [ 26 ]. This perspective shifts away from a linear consideration of family processes by recognizing the multiple recursive influences that shape family relationships and family functioning, perceiving it as an ongoing process throughout the life cycle [ 27 ].
Systemic family therapy has been shown to be an efficacious intervention for families and adolescents with a wide range of mental health problems, such as drug use [ 19 , 28 , 29 , 30 , 31 , 32 ] , eating disorders [ 29 , 30 ] and both internalizing and externalizing disorders [ 19 , 29 , 30 , 31 , 33 , 34 , 35 , 36 ]. Despite these advances, most of the literature has focused on either systemic family therapy as a whole, without taking into account the different approaches embedded within this framework, or on the effectiveness of more manualized approaches, such as multisystemic family therapy e.
Few studies have examined the effectiveness of more classical and widely used approaches, such as structural and strategic family therapy [ 39 ]. Hence, more research is needed to be able to draw more definite conclusions regarding the use of these types of family therapy approaches. Structural family therapy is one of the dominant approaches in systemic family intervention, originally created by Minuchin [ 40 ].
The focus of this approach is on achieving a healthy hierarchical family organization, where there are different subsystems with their limits and boundaries [ 27 , 41 ]. According to this approach, the difficulties expressed by the adolescent are a reflection of: 1 A family structural imbalance; 2 a dysfunctional hierarchy within the family system, often characterized by difficulties in establishing boundaries between the parental and the child subsystem; and 3 a maladaptive reaction to changing demands [ 27 ].
It also emphasizes the need to adjust the rigidity of the limits and the relationship between subsystems according to the moment of the life cycle [ 42 ]. During adolescence, while authority still relies on the parental subsystem, the way it is exerted cannot be the same as in previous developmental stages, and the limits between the subsystems, while remaining clear, have to be more flexible [ 25 , 27 , 42 ].
Although the core elements of this approach are well established and widely used among the clinical community [ 30 , 43 ], few studies have addressed the effectiveness of this approach for adolescents with mental health problems [ 39 , 44 ].
Handbook of Family Therapy by Gurman Alan S Kniskern David P - AbeBooks
Strategic family therapy is purely embedded within the systemic model and has a more directive impression [ 25 , 45 ]. From this approach, the symptom is considered as serving a function to the family, as well as reflecting a difficulty of the family to solve a problem [ 25 , 27 , 45 ]. According to the strategic approach, when faced with a problem, families adopt solutions that have been useful to them in the past.
However, symptoms such as behavioral or emotional difficulties or an increase in conflicts emerge for which those solutions are no longer valid, and the family is unable to find and effectively use alternative ones; thus, they become stuck in a symptom-maintaining sequence [ 27 ]. The objective of this therapy is for the family to initiate actions and solutions that are different to the ones previously attempted [ 27 , 45 ].
There is extensive evidence about the effectiveness of the brief—strategic family therapy approach, which is a manualized and specific variant of the strategic approach, with different populations [ 46 ], including adolescents with mental health problems e. Though structural and strategic family therapy are conceptually two different approaches within the systemic framework, they share certain core elements, and it is not rare to use them conjointly. Some illustrative examples are brief—strategic family therapy and multisystemic therapy, both of which incorporate representative elements from both approaches.
In general, literature has shown that systemic family therapy has a significant impact by reducing internalizing and externalizing symptoms of adolescents, as well as improving overall family functioning [ 35 , 36 ]. In addition, most studies have focused on individual outcomes or on family functioning as a whole, rather than incorporating parent—child dyadic measures or parental dyadic measures.
Research has shown that some of these dyadic dimensions play an important role in families with adolescents with mental health problems; they should therefore be incorporated in effectiveness evaluations. More specifically, coercive and permissive parenting practices [ 50 , 51 , 52 ] have generally been considered as two of the most important predictors of internalizing and externalizing problems. Other parenting dimensions linked to child psychopathology include: Low sense of parental competence, defined as the perception parents have of their own performance as parents [ 52 , 53 , 54 ], and high levels of interparental conflict [ 55 ].
As a result, parental practices, sense of parental competence, and parenting alliance constitute intervention targets and should be included in effectiveness evaluations. For some of these dimensions, the studies available highlight the need to control gender differences. Specifically, there is evidence of important differences in parenting practices between mothers and fathers, with mothers scoring higher in communication and control dimensions [ 56 , 57 , 58 ]. In addition, there is evidence of gender differences in the perception of parenting alliance and co-parenting; more specifically, in parental support and involvement dimensions.
Thus, mothers are more likely to be involved in parental decision-making processes than fathers but also feel less supported in their parental role [ 59 ]. In this framework, the goal of this study was to evaluate the effectiveness of structural—strategic family therapy on different individual, dyadic, and family dimensions in families with an adolescent with a mental health problem; to do so, we conducted a comprehensive analysis and incorporated a gender perspective.
According to previous evidence on systemic family therapy, we expected a reduction of internalizing and externalizing symptoms of adolescents, as well as an improvement in family functioning. Due to their role in child psychopathology, a reduction of coercive and permissive parenting practices as well as an increase in sense of parental competence and parenting alliance were hypothesized.
This study was part of a wider research project assessing the effectiveness of a structural—strategic family therapy SSFT initiative run by mental health services in Southern Spain Andalusia for families with an adolescent with a mental health problem. The family therapy sessions initially focused on establishing a therapeutic alliance with all members of the family, providing them with a safe, nonjudging space where all of them felt understood. Afterwards, the objectives of the sessions were to set clear boundaries between the subsystems, to strengthen the parental subsystem encouraging joint decision-making and teamwork, to highlight and balance parental authority with the increasing need for autonomy from the adolescent, and to reframe the relationships within the family system.
The intervention was led by two therapists trained in structural and strategic family therapy a clinical psychologist and a psychiatrist.
Stephen R Lankton
On average, the treatment consisted of a one-hour session each month over a period of approximately 10 months [ 60 ]. For the purpose of the evaluation, a quasi-experimental design was followed, including a pre-test versus post-test evaluation of the participants of an experimental group EG. The sample consisted of 41 participants Most families were two-parent Following ICD criteria, behavioral disorders were the most common diagnoses Other less frequent diagnoses included personality disorders 9.
The study followed a multi-informant approach, collecting information from practitioners, caregivers, and target adolescents. In this paper, information provided by practitioners and caregivers is included. Practitioners provided information about adolescent and family sociodemographic profiles. Caregivers informed about the target adolescent behavior, as well as about their parental sense of competence, parental practices, perceived parenting alliance, and perceived family functioning.
These measures are described below. Child behavior checklist for ages 6—18 [ 61 ]: This inventory provides information on child and adolescent behaviors from the perspective of caregivers. It measures both positive competences and problem behaviors internalizing and externalizing. Higher scores indicate greater behavior problems. Mean scores were computed. Parental sense of competence [ 62 ]: This scale explores perceived competence as a parent.
It consists of 16 items with responses on a six-point scale.
Two subscales can be computed, measuring efficacy and satisfaction in parenting. For both subscales, mean scores were computed, with higher scores indicating greater parental sense of competence. Parenting styles and dimensions questionnaire [ 63 ]: This item instrument consists of three scales measuring authoritarian, authoritative, and permissive parenting.
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Parenting alliance inventory [ 64 ]: This item scale assesses the degree of commitment and cooperation between husband and wife in child rearing. For each item, parents respond on a 5-point scale. We used the mean score, with higher scores indicating stronger support between partners as parents.
Family cohesion and adaptability scale [ 65 ]. It is ranked on a 5-point scale. Unlike other versions, the scores assessed with FACES-III are interpreted in a linear manner, so the higher the score, the greater the level of family cohesion and adaptability. Mental health practitioners referred the families for SSFT intervention. If the intervention criteria were met, SSFT practitioners enrolled the family in the trial if they had an adolescent member 10 years or older.
Two trained researchers, external to the SSFT, interviewed the caregivers and practitioners of each family and assessed the adolescents at the mental health service facilities. The pre-test was completed before the first SSFT session, and the post-test in the last session for those families that had attended at least three intervention sessions. The average length of time between pre- and post-test assessment was 10 months, which corresponded approximately to the school year.
Every informant participated in the study voluntarily, after signing an informed consent form in accordance with the Declaration of Helsinki. The aims of the research project were explained, and all participants were assured that their anonymity would be protected. No monetary incentives were offered. The flow of cases through the trial is shown in Figure 1. Patients were classified as dropouts if they did not complete Time 2 assessment protocols, despite being contacted at least three times by the research team.