Couples and Family Psychotherapy: Part 1 - 2nd Edition

Educational Objectives

Upon completing this educational activity, participants will be able to:
1. Utilize knowledge of recent developments in genetics and neuroscience to more effectively diagnose and manage psychiatric disorders.
2. Discuss optimal diagnosis, treatment, and clinical understanding of bipolar disorder.
3. Identify and overcome barriers to the effective management of personality disorders.
4. Identify and manage key factors that may affect a patient's risk for violent behavior.
5. Recognize common causes of treatment failures in patients suffering with anxiety and depression.
6. Implement therapy techniques for managing patients with somatic disorders.

Summary

Couples and Family Psychotherapy: Part 1

Ira D. Glick, MD, Professor Emeritus of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, and Chief of the Schizophrenia Clinic, Stanford Hospital, Stanford, California

Introduction: family therapy roots in social psychiatry in 1950s; change behavior through social context; systems therapy seeing patient in context of system; family therapy moved away from psychiatry and medicine; therapists needed to be trained to negotiate; family seen as resource for positive change

Definitions: distinguished by conceptual focus on family as whole; major emphasis placed on understanding whole system function; alterations in larger marital and family unit have positive consequences; systematic effort to produce beneficial changes in marital or family unit; establishment of satisfying ways of living for entire family and individual family members; not always clear whether family interaction cause or effect of disturbed behavior

Core concepts: general systems theory combined systems view of interactions of how family functions; system must have boundaries, open for interaction with other people; cultural variations must be taken into context; family in homeostasis; homeostasis keeps family going from past to future; dysfunction from lack of homeostasis, family does not evolve; integrate interpersonal model with developmental and individual model; family therapy focused on family; individual therapy focus on individual unconscious conflicts, thoughts, wishes, behaviors; group therapy focus in group; elements overlap; families used to produce, now they consume; women and children seen as chattel, no recognition of their separate needs; life of family private; family more public through religion, social interactions; therapist to understand change from traditional family; kinship systems; birth control, increased remarriage rate, increased divorce rate to 50%, delay having children; therapists avoid displacing own values; therapists need to evaluate each family system; understanding functional family system; connectedness and commitment of members; respect for individual differences and autonomy; couples relationship characterized by mutual support and respect; nurturing, protection, socialization of children; organizational stability; adaptability; open communication; effective problem solving and conflict resolution; shared belief system; adequate resources for economic, security, psychosocial support; family life cycle; early adulthood 20 to 40, mid-adulthood 40 to 60, older adulthood 60 plus; life cycle must be integrated with individual life cycle; Erikson’s stages mastered and integrated with family life cycle phases; marital coalition core; issues of power, closeness in distance, separateness and intimacy, marital commitment, intimacy; all dimensions to be worked out in terms of dysfunction; family tasks provide basic physical needs, rearing and socializing children, using age-appropriate child-rearing techniques, keep parental coalition together; alternative family forms serial relationships, cohabitating, marital separation and divorce; binuclear families; functioning for gay and lesbian families; family function key; stable relationship buffers genetic vulnerability to medical and psychiatric disorders; dysfunction structural problems, enmeshment, triangulation, stable coalition; solution as a problem is concept in family work; therapists deal with problem and solution to more functional model; family beliefs and myths; member of family identified as patient; understand basic concepts and deal with them

Conducting family evaluation: continuing process, not complete at any particular point; historical material; cross-sectional approach; focus on particular crisis or how particular individual formed; overall picture of family and individual members; role of individual in family diagnosis; need for evaluation of individual family members; dimensions of family function; problem areas communication, problem solving, roles in coalition, affective responsiveness and involvement, behavior control, operative family beliefs, areas; pull together into family classification diagnosis dynamic and formulation; family goals, expectations of treatment; strengths, motivations, resistance; formulate problem areas; goals and planning approach; role of genogram; always recommend family visit; psychological tests not part of family therapy; develop diagnosis (family and individual)

Planning therapeutic approach: agree on goals with family; individualizing goals with family; median goals, specify problems, clarify solutions, clarify individual desires and needs, modify individual expectations, needs, recognition of mutual contributions to problem, redefining problems, improving communication skills, shifting inflexible roles and coalitions, psychoeducation including knowledge about psychiatric illness; insight into historical factors sets stage for final goals; layout in terms of process and content issues; support adoptive mechanisms; expand emotional experience; teach how to listen and share feelings; develop interpersonal skills; reorganize family structure to share power; increase insights using traditional psychodynamic individual techniques (clarification, confrontation, interpretation); help family understand and modify narratives

Treatment strategies and techniques: strategies for supporting adaptive mechanisms, spanning individual and family emotional experience, explicit development of interpersonal skills, reorganizing family structure, increasing insight and intrapsychic conflict resolution, helping family find new more positive ways of understanding situation; develop treatment package with combination techniques or integrated with other modalities; emphasize integrating different models; family therapist like symphony conductor; getting started, building alliance, early, middle, late parts of therapy; clear differentiation between evaluation and treatment; middle stage major work takes place, crucial turning point; termination phase, goals achieved or not achieved; review course of therapy; medical model, coaching model, conflict model, systems model; family therapy tries to change family to change individuals; disconnection, resistance difficulties; therapist countertransference; mismatch between therapist and family; disagreement about goals; deal with problems and resistances; family secrets; stalled therapy; obtain consultation; assume nothing; emphasize family responsibility; focus on present; make careful outline of time, scheduling, fees at beginning; session duration depends on goals of treatment; missed appointments should be rescheduled; keep record of treatment; combine family therapy with other psychosocial therapies; pharmacotherapy and Axis I disorder considerations; provide structured format open contact with family; respect for interpersonal boundaries; educating, communicating, problem-solving skills

Summary: review of definitions, core concepts, functional and dysfunctional families, history of sociology of families; family evaluation; setting goals; family treatment and resistance to treatment

Readings

Disclosures

Acknowledgements

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

PSBR160153

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

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