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Family Therapy

Family Therapy. as a Treatment Modality for Substance Abuse in Adolescence. Maeve Dwan - November 2006. Overview What is Family Therapy? Central Philosophy Family Therapy in the Young Persons Programme A Systemic Conceptualisation Broad Goals of Family Therapy in substance misuse

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Family Therapy

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  1. Family Therapy as a Treatment Modalityfor Substance Abuse in Adolescence Maeve Dwan - November 2006

  2. Overview • What is Family Therapy? • Central Philosophy • Family Therapy in the Young Persons Programme • A Systemic Conceptualisation • Broad Goals of Family Therapy in substance misuse • YPP Roadmap for Family Therapy • Engagement and Retention • Parents Feedback

  3. What is Family Therapy (Systemic Psychotherapy)? • What is the focus of Family therapy? • Who should be included? • What do family therapists do?

  4. Central Philosophy • Interconnectedness of people and beliefs • Emotional, psychological and interpersonal difficulties arise in patterns of social engagement • Rules that connect the parts of a system (the family) are as important as the system components (family members) • Includes the clients context in the therapy

  5. Family Therapy in Young Persons Programme (YPP) • Ensure a central role for families in relation to the young persons treatment • Integrate the knowledge's from the field of substance misuse treatment with those from the field of Family therapy

  6. A Systemic Conceptualisation • “Within a family systems framework the drug using adolescent is a family member who displays symptoms including drug using and co-occurring difficulties. These difficulties are understood or indicative at least in part of what else is going on in the family system” • (Szapocnik and Kurtines, 1989)

  7. Role of Families in Substance Misuse Treatment • Prevent and/or influence course of substance misuse • Improve substance related outcomes for the user • Reduce negative effects on other family members

  8. Broad Goals of Family Therapy • Create a therapeutic relationship with the family • Preserve the family unit • Identify patterns of interaction associated with the adolescents behaviour (genesis and maintenance) • Change patterns of family interaction to more adaptive and effective patterns of relating

  9. Broad Goals of Family Therapy (Cont’d) • Engage and retain families in treatment • Reframe negativity • Change family boundaries and alliances • Open up closed family systems or subsystems • Validate and support family as a system and attend to each individual family members experience

  10. “It is often assumed that drug users lead a chaotic, transient lifestyle isolated from their families, and many clinicians are therefore sceptical about the possibility of involving the family actively in treatment” • (Yandoli et al 2002)

  11. Co-occurring Problems • Conduct problems at home or at school • Oppositional behaviour • Anti social behaviour • Aggressive and violent behaviours • Risky sexual behaviours

  12. YPP Roadmap for Family Therapy • Introduce idea of Family Therapy at initial assessment • Informal introduction of Family Therapist • Offer meeting once evidence of stabilisation • Explore families desire to engage and perceived benefits • May span a number of sessions • May involve contact with variety of family members/network • Develop alliance with sufficient family members • Work with whoever shows up! • Develop a contract for therapy • Negotiate duration and goals

  13. Approaches that have yielded significant outcomes • Multisystemic Family Therapy (Henggeler, 1999) • Brief Strategic Family Therapy (Szapocznik et al, 1986) • Multidemensional Family Therapy (Liddle, 2002a) • Functional Family Therapy (Alexander & Parsons, 1982) • Family Couples Therapy (Stanton & Shadish,1997) • Family Systems Therapy (Joanning et al, 1992)

  14. Engagement and Retention • Gain trust and respect • Respect families’ existing structure • Do not force change or confrontation • Deal with idea of secrets • Use families’ language • Agree rules for attendance while drug affected

  15. Parent Feedback: Expectations • Initially unreceptive • Family Therapy implied blame • Attendance meant acceptance of blame • Problem was with our daughter • Afraid of being judged as parents • Afraid of bias in favour of daughter against parents • Could not see how therapy would be useful • Participated only to please YPP and daughter

  16. Parent Feedback: Experience • Has made positive impact • More open communication than occurred previously • No one allowed to dominate • Allowed discussion of sensitive topics in controlled way • Discussion without ending in unresolved argument • Gives everyone a voice • Relaxed and non-judgemental • Chance to see how patterns have developed • Discussions that may otherwise have been too painful

  17. “The therapist has acted as a neutral facilitator of the discussions, while also providing input (almost exclusively in the form of questions rather than statements) as required. The therapist acts also as a kind of chairperson at the session, summarising what she thinks is being said etc as needed” • (Parent, 2006)

  18. There is an increasingly robust evidence base that supports both family and social network focused intervention in substance misuse treatment • (Coppello, Templeton & Vellerman, 2006)

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