Family therapy

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Family therapy

Meaning
Family therapy assumes an individual’s psychiatric symptoms are related to family in which he lives. Thus focus of treatment is not the individual but the family.
Definition
Family therapy is an interpersonal therapeutic technique applied to family.
Family therapies are aimed at patients, as well as their family.
Indications
Family therapy is indicated when there is relational problem or marital problem within the family which can occur in almost all the psychiatric problems
·         Psychoses
·         Anxiety disorders
·         Psychosomatic disorders
·         Substance abuse
·         Child hood psychiatric problems
Components of therapy
·         Assess family structure, roles, boundaries, resources
·         Teach communication skills
·         Teach problem solving skills
·         Write behavioral marital contract
·         Homework assignments
Types of family therapy
l . Individual family therapy-
Here each family member will have a separate single therapist. They will work out specific issues that have been defined by individual member
2.   Conjoint family therapy-
Here nuclear family is seen and the issues, problem raised by the family is addressed by the therapist. The way in which family interacts is observed and becomes focus of therapy
3.   Couples therapy-
Couple may be experiencing difficulties in marriage, and in this therapy they are helped to work together to seek a resolution Of their problem . examiner enables couple to find a common ground for resolving conflict by recognizing and respecting each other similarities and differences family pattern, partners goal, hopes, expectation, communication style are examined in this therapy.
4. Multiple family group therapy-
Here four or five family meet weekly to deal with problems or issue in common. It also encourages each person to reach out and form new relation outside the group. Common problems discussed are ability or inability to function well in the home and community, fear of talking to or relating to others, abuse, anger, neglect, development of social skills, and responsibilities for oneself etc
5.   Multiple impact therapy-
here several therapist will come together with the family in community setting. This is same as multiple group therapy but is intense and time limited. It focuses on developing skills or working together as a family and with other families
6.   Network therapy-
Usually conducted in people's home.This includes family, friends, neighbors, professional groups or persons. People in network generally know each other and interact on regular basis A network includes 40-60 people.
Patient selection
·         Referred to treatment by private physicians and agencies such as school system, welfare board, parole officers, and judges.
·         ER after a crisis in the family
·         On discharge
·         Marital problem or sibling conflict
·         Situational crisis
·         Maturational crisis
APPROACHES
Major Family Therapy Approaches
l .   Object Relations.
2.   Experiential.
3.   Trans-generational.
4.   Structural.
5.   Strategic
6.   Cognitive-Behavioral.
7.   Social Constructionist
8.   Narrative.
Major Family Therapy Approaches
1.   Object Relations.
Satisfying relationship with some "object" (e.g., parent) is a fundamental need. Help client gain insight into early relationships (objects from past) and how it affects current relationships enabling individual development and fulfilling relationships.
2.   Experiential:
Troubled families need a "growth experience" derived from an intimate interpersonal experience (therapy).
By being real (authentic) and disclosing families learn to be more honest, more expressive, and better able to achieve personal and interpersonal growth.
3.   Experiential:
Building self-esteem and learning to communicate openly are essential goals. Helping family members probe their own world of symbolic meanings frees them to activate innate growth processes.Example of this approach is: Emotionally-Focused Couple Therapy
4.   Transgenerational:
Thinking, feeling, and behaving are tied to the family system. The individual's problems arise and are maintain by relationship connections. Problems are passed from one generation to the next
Fusion - most vulnerable
Differentiation of self- least vulnerable
5.   Structural:
Focused on how families are organized and what rules govern their transactions. Pays attention to rules, roles, alignments, and boundaries. Challenges rigid, repetitive transactions within a family, helping to "unfreeze" them and allow family reorganization.
6.   Strategic:
Assigns tasks to get family to change aspects of the system that maintain problematic behavior.
7.   Cognitive-Behavioral:
Maladaptive behaviors can be extinguished as the contingencies of reinforcement are altered
·         Communication skills
·         Parent training skills
·         Cognitive restructuring
8.   Social Constructionist
·         Each of our perceptions is not an exact duplication of the world, rather, a point of view seen through the limiting lens of our assumptions about people.
·         Jointly construct new options that change past accounts and allow new alternatives.
9.   Narrative:
Our sense of reality is organized and maintained through stories. Families present with negative, dead-end stories.
The goal is to explore alternative stories, make new assumptions, and open up new possibilities by re-authoring stories.
The therapist's role
·         He never appears as the Almighty, official operator, example or model for the family.
·         He collaborates with all the members of the team involved.
·         During the first interview, the therapist looks for the family's motivations and encourages them to avoid resistances.
·         He keeps away the risk of blames, in order to get the best participation possible.  
·         One or two sessions to structure the group
·         The family therapist sometimes gets a feeling of intrusion or even violation of the family's intimacy.
Guidelines for therapist
l. Address the families to work together with family therapist.
2.   Orient family to therapy process through role induction
3.   Join with the family before gathering sensitive information
5.   Do home visits
6.   Use problem solving
7.   Be creative and flexible
Nurses role
·         To co-ordinate treatment
·         To pay attention to social and clinical needs of patient and family
·         To provide optimum medication management
·         To listen to families and treat them as equal partners
·         To explore family expectation
·         To asses family's strength, problems and goals.
·         To promote clear communication and active listening.
·         To provide training in structured problem solving technique.
·         To encourage family to expand social support network
·         To encourage family to adjust their expectation
·         To provide follow up contract


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notes.nursium.com: Family therapy
Family therapy
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