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Academic Psychiatry

, Volume 32, Issue 5, pp 405–413 | Cite as

Reinventing Family Therapy: Teaching Family Intervention as a New Treatment Modality

Original Article

Abstract

Objective

This article discusses the pedagogy of teaching family therapy in the new millennium. It draws on the strengths of “family systems therapy” but goes beyond it—suggesting a new paradigm, new terminology, and a new teaching perspective. It discusses the historical background of family therapy training, a scientific foundation for what residents should be taught, and an integrative clinical model for how it could be taught.

Methods

The article is the synthesis of the perspectives and experience of a child and adolescent psychiatrist educator who began his career at the end of the systemic era in psychiatry and continues it through the developments of the neurobiologic era. It draws on selected literature from the fields of family therapy, child and adolescent psychiatry, developmental psychopathology, and general psychiatry.

Results

This article submits that the term “family therapy” should be replaced by the term “family intervention”; the evidence base indicates that family interventions are effective; family risk and protective factors influence the onset and course of disorders; families help shape and maintain cognitive schema; intervention must start with thorough case formulation; and family interventions should be coordinated with other interventions, include parent management training and build on family strengths.

Conclusion

Family intervention is an important clinical process in child and adolescent psychiatry, and contemporary education must address the multiple ways clinicians can assist families. Future models will be successful to the degree they build on the past contributions of systems thinking and include the perspectives of developmental psychopathology. Contemporary education should teach that family interventions are not optional but ideally can be integrated with other interventions in a sequential manner, emphasizing the interrelationship between self and system.

Keywords

Family Therapy Academic Psychiatry Adolescent Psychiatry Family Interaction Acad Child Adolesc Psychiatry 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Josephson AM: Family therapy in an age of biological psychiatry: diagnostic and treatment considerations, in Children in Family Contexts: Perspectives on Treatment. Edited by Combrinck GL. New York, Guilford Press, 2006Google Scholar
  2. 2.
    Fraenkel P: Whatever happened to family therapy? Psychotherapy Networker 2005; 29: 30–39, 70Google Scholar
  3. 3.
    Accreditation Council for Graduate Medical Education: Psychiatry Program Requirements, 2007 update. ACGME Program Requirements for Graduate Medical Education. Available at www.acgme.org/acWebsite/RRC_400/400_prIndex.asp
  4. 4.
    Slovik LS, Griffith JL, Forsythe L, et al: Redefining the role of family therapy in psychiatric residency education. Acad Psychiatry 1997; 21: 35–41Google Scholar
  5. 5.
    Broderick CB, Schrader SS: The history of professional marriage and family therapy, in Handbook of Family Therapy. Edited by Gurman AS, Kniskern DP. New York, Brunner/Mazel, 1991Google Scholar
  6. 6.
    Josephson AM: Family therapy, in Child and Adolescent Psychiatry: A Comprehensive Textbook, 3rd ed. Edited by Lewis M. Philadelphia, Lippincott Williams & Wilkins, 2002Google Scholar
  7. 7.
    Gurman AS, Kniskern DP (eds): Handbook of Family Therapy, Vol. II. New York, Brunner/Mazel, 1991Google Scholar
  8. 8.
    Kramer DA: The biology of family psychotherapy. Child Adolesc Psychiatric Clin N Am 2001; 10: 625–640Google Scholar
  9. 9.
    McDermott JF, Char WF: The undeclared war between child and family therapy. J Am Acad Child Adolesc Psychiatry 1974; 13: 422Google Scholar
  10. 10.
    Sprenger DL, Josephson AM: Integration of pharmacotherapy and family therapy in the treatment of children and adolescents. J Am Acad Child Adolesc Psychiatry 1998; 37: 887–889PubMedCrossRefGoogle Scholar
  11. 11.
    Josephson AM: “The Clinical Process of Sequencing Therapies: When, What, How.” Scientific Proceedings of the Annual Meeting of the American Academy of Child and Adolescent Psychiatry, Vol. 17, p 14, 2001Google Scholar
  12. 12.
    Malone CA: Child and adolescent psychiatry and family therapy. Child Adolesc Psychiatr Clin N Am 2001; 10: 395–413PubMedGoogle Scholar
  13. 13.
    Josephson AM, Serrano A: The integration of individual therapy and family therapy in the treatment of child and adolescent psychiatric disorders. Child Adolesc Psychiatr Clin N Am 2001; 10: 431–450PubMedGoogle Scholar
  14. 14.
    Nichols M: The Self in the System: Expanding the Limits of Family Therapy. New York, Brunner/Mazel, 1987Google Scholar
  15. 15.
    Josephson AM: Preface, in Child Adolesc Psychiatr Clin N Am: Current Perspectives on Family Therapy 2001; 10: xiii–xviiGoogle Scholar
  16. 16.
    Diamond G, Siqueland L: Current status of family intervention science. Child Adolesc Psychiatr Clin N Am 2001; 10: 641–661PubMedGoogle Scholar
  17. 17.
    Josephson A, Moncher F: Family treatment, in Handbook of Child and Adolescent Psychiatry, Vol. 6. Edited by Noshpitz JD. New York, Wiley, 1998, pp 294–312Google Scholar
  18. 18.
    Diamond G, Josephson A: Family-based treatment research: a 10-year update. J Am Acad Child Adolesc Psychiatry 2005; 44: 873–887CrossRefGoogle Scholar
  19. 19.
    Beach SR, Wamboldt MZ, Kaslow NJ, et al: Relational Processes and DSM-V: Neuroscience, Assessment, Prevention, and Treatment. Arlington, Va, American Psychiatric Publishing, 2006Google Scholar
  20. 20.
    Wood BL, Miller BD, Lim J, et al: Family relational factors in pediatric depression and asthma: pathways of effect. J Am Acad Child Adolesc Psychiatry 2006; 45: 1–9CrossRefGoogle Scholar
  21. 21.
    Heru AM: Family psychiatry: from research to practice. Am J Psychiatry 2006; 163: 962–968PubMedCrossRefGoogle Scholar
  22. 22.
    Berman EM, Heru AM, Grunebaum H, et al: Family skills for general psychiatry residents: meeting ACGME core competency requirements. Acad Psychiatry 2006; 30: 69–78PubMedCrossRefGoogle Scholar
  23. 23.
    Sroufe LA: Attachment and development: a prospective, longitudinal study from birth to adulthood. Attach Hum Dev 2005; 7: 349–367PubMedCrossRefGoogle Scholar
  24. 24.
    Sargent J: Variations in family composition: implications for family therapy. Child Adolesc Psychiatric Clin N Am 2001; 10: 577–599Google Scholar
  25. 25.
    Cicchetti D, Cohen DJ (eds): Developmental Psychopathology, Vol. 3: Risk, Disorder, and Adaptation. New York, Wiley, 2006Google Scholar
  26. 26.
    Kim-Cohen J: Resilience and developmental psychopathology. Child Adolesc Psychiatric Clin N Am 2007; 16: 271–283CrossRefGoogle Scholar
  27. 27.
    Carrey N, Ungar M (eds): Resilience: Child and Adolescent Psychiatric Clinics of North America, Vol. 16, No. 2, 2007Google Scholar
  28. 28.
    Luthar SS: Resilience in development: a synthesis of research across five decades, in Developmental Psychopathology, Vol. 3: Risk, Disorder, and Adaptation, 2nd ed. Edited by Cicchetti D, Cohen DJ. Hoboken, NJ, Wiley & Sons, 2006, pp 739–795Google Scholar
  29. 29.
    Smith G: Therapist reflections: resilience concepts and findings: implications for family therapy. J Fam Ther 1999; 21: 154–158CrossRefGoogle Scholar
  30. 30.
    Zeanah CH, Zeanah PD: Intergenerational transmission of maltreatment: insights or attachment theory and research. Psychiatry 1989; 52: 177–196PubMedGoogle Scholar
  31. 31.
    Stern DN: The Interpersonal World of the Infant. New York, Basic Books, 1985Google Scholar
  32. 32.
    Siegel DJ: The Developing Mind: Toward a Neurobiology of Interpersonal Experience. New York, Guilford Press, 1999Google Scholar
  33. 33.
    Klinnert MD, Butterfield P, et al: Social referencing: the infant’s use of emotional signals from a friendly adult with mother present. Dev Psychol 1986; 22: 427–432CrossRefGoogle Scholar
  34. 34.
    Reiss D: The represented and practicing family: contrasting visions of family continuity, in Relationship Disturbances in Early Childhood: A Developmental Approach. Edited by Sameroff A, Emde R. New York, Basic Books, 1989, pp 191–220Google Scholar
  35. 35.
    Garber J, Flynn C: Predictors of depressive cognitions in Young adolescents. Cognnit Ther Res 2001; 25: 353–376CrossRefGoogle Scholar
  36. 36.
    Scharff JS (ed): Foundations of Object Relations Family Therapy. Northvale, NJ, Jason Aronson, 1989Google Scholar
  37. 37.
    Eisenberg L: Nature, niche, and nurture: the role of social experience in transforming genotype into phenotype. Acad Psychiatry 1998; 22: 213–222Google Scholar
  38. 38.
    Engel G: The clinical application of the biopsychosocial model. Am J Psychiatry 1980; 137: 535–544PubMedGoogle Scholar
  39. 39.
    Thomas A, Chess S: The Dynamics of Psychological Development. New York, Brunner/Mazel, 1980Google Scholar
  40. 40.
    Garmezy N, Rutter M (eds): Stress, Coping, and Development in Children. Baltimore, Johns Hopkins University Press, 1988Google Scholar
  41. 41.
    Rice F, Harold GT, Shelton KH, et al: Family conflict interacts with genetic liability in predicting childhood and adolescent depression. J Am Acad Child Adolesc Psychiatry 2006; 45: 841–847PubMedCrossRefGoogle Scholar
  42. 42.
    Anders T: Clinical syndromes, relationship disturbances, and their assessment, in Relationship Disturbances in EarlyChildhood: A Developmental Approach. Edited by Sameroff AJ, Emde RN. New York, Basic Books, 1989Google Scholar
  43. 43.
    Nurcombe B, Drell M, Leonard H, et al: Clinical problem solving: the case of Matthew, part 1. J Am Acad Child Adolesc Psychiatry 2002; 41: 92–97PubMedCrossRefGoogle Scholar
  44. 44.
    Kazdin AE: Practitioner review: psychosocial treatments for conduct disorder in children. J Child Psychol Psychiatry 1997; 38: 161–178PubMedCrossRefGoogle Scholar
  45. 45.
    Minuchin S, Fishman HC: Family Therapy Techniques. Cambridge, Mass, Harvard University Press, 2004Google Scholar
  46. 46.
    Tomm K: Interventive interviewing: part II. Reflexive questioning as a means to enable self-healing. Fam Process 1987; 26: 167–183PubMedCrossRefGoogle Scholar
  47. 47.
    Weissman MM, Pilowsky DJ, Wichramaratne PJ, et al: Remissions in maternal depression and child psychopathology. JAMA 2006; 295: 1389–1398PubMedCrossRefGoogle Scholar
  48. 48.
    Combrinck-Graham L: Children in families in communities. Child Adolesc Psychiatric Clin N Am 2001; 10: 613–624Google Scholar
  49. 49.
    Roberts EJ: A rush to medicate young minds. Washington Post, Oct 8, 2006, p B07Google Scholar
  50. 50.
    Josephson A, Moncher F: Family history, in Handbook of Child and Adolescent Psychiatry, Vol 5. Edited by Noshpitz JD. New York, Wiley, 1998, p 284–296Google Scholar
  51. 51.
    Josephson AM, AACAP Work Group on Quality Issues: Practice parameter for the assessment of the family. J Am Acad Child Adolesc Psychiatry 2007; 46: 922–37PubMedCrossRefGoogle Scholar
  52. 52.
    Josephson A, Moncher F: Observation, interview, and mental status assessment (OIM): family unit, in Handbook of Child and Adolescent Psychiatry, Vol 5. Edited by Noshpitz JD. New York, Wiley, 1998, p 393–414Google Scholar
  53. 53.
    Fishman HC: Intensive Structural Therapy: Treating Families in Their Social Context. New York, Basic Books, 1993Google Scholar
  54. 54.
    Barker P: Basic Family Therapy, 4th ed. Malden, Mass, Blackwell Science, 1998Google Scholar
  55. 55.
    Canino IA, Inclan JE: Culture and family therapy. Child Adolesc Psychiatric Clin N Am 2001; 10: 601–612Google Scholar
  56. 56.
    Josephson AM, Dell ML (eds): Child and Adolescent Psychiatric Clinics of North America: Religion and Spirituality, Vol. 13, No. 1, 2004Google Scholar

Copyright information

© Academic Psychiatry 2006

Authors and Affiliations

  1. 1.Division of Child and Adolescent PsychiatryUniversity of LouisvilleLouisvilleUSA

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