Family intervention had no effect on the number of individuals who killed themselves during the follow-up periods of the studies. The purpose of this systematic review and meta-analysis was to synthesize the available evidence on family therapeutic intervention impacts on reducing perinatal depressive symptoms and improving family functioning. A total of 801 mothers and their partners (control group n = 385; intervention group n = 416) participated in all seven studies included in the meta-analysis. Although statistical methods exist for imputing correlations, we were not comfortable using these methods and we assumed that baseline and follow-up measures were not correlated. Feature Flags last update: Thu Dec 24 2020 21:07:16 GMT+0000 (Coordinated Universal Time) Results suggest that family therapy reduces the number of health care visits, especially for high utilizers. For this reason, we do not have data on the percentage of women who receive family therapy for the prevention or treatment of perinatal depression. There are at present only few reliable data regarding the efficacy of systemic therapy for adults with anorexia nervosa. Overall, the results revealed a trend in improving family functioning (SMD = -0.155, 95% CI = -0.339, 0.029; z = 1.65, p = .10; I2 = 0.0%). Experimental intervention groups were compared to control groups comprised of standard care, treatment as usual, wait-listed, or no care conditions. A health economic analysis demonstrated that antidepressant treatment is no cheaper than systemic couple therapy. ‘Family’ is open to many interpretations, if not attacks, because it is frequently read as implying a two-parent, heterosexual couple with two children, with the woman primarily the ‘homemaker’ and the man the ‘breadwinner’, with occasional backup from the grandparents. 2007. As shown in Table 1, most of the studies included interventions that are based in cognitive-behavioral couple therapy. For this reason, we did not define these systemic interventions as couple therapeutic interventions. 2008. Review Manager 5.344 software used to create Fig 2. https://doi.org/10.1371/journal.pone.0198730.g002. When looking at outcome, it emerged that the majority of deaths in the family intervention and the control groups were owing to suicide (4%). First, the interventions examined by us and others [10–11, 13, 41–43, 46] primarily focus on preventive psychosocial interventions or psychosocial treatments that aim to reduce perinatal depressive symptoms. SCHWEITZER, JOCHEN Level of family involvement was dichotomized using the mean percentage of sessions attended by family members (79% or fewer sessions = 2 studies; 80% of sessions or more = 3 studies). Furthermore, health insurance companies may vary in level of reimbursement for family therapy by provider type. and Case illustrations will then be used to show how the supervisor of a family treatment case elicited the countertransference in order to move the therapy forward. The studies that met inclusion criteria included systemic interventions applied to both parents/primary caregivers who were either expecting a baby or who had at least one infant. Eighty-four out-patients were randomised to four different treatments: (1) focal psychoanalytic psychotherapy, (2) cognitive-analytic therapy, (3) family therapy and (4) routine treatment that served as a control. Following an overview of the theoretical foundations undergirding this therapeutic approach, a case study is used to illustrate the use of numerous NFT techniques. The TIP provides basic information about family therapy for substance abuse treatment professionals and basic information about substance abuse treatment for family therapists. schizophrenia, depression or alcohol dependency). McVoy, Molly Two treatment studies and five prevention studies were included in the meta-analysis. As originally hypothesized, our analysis of level of family involvement showed that mothers of family members who attended at least 80% of the preventive intervention sessions experienced a statistically significant decrease in depressive symptoms when compared to those of family members who attended fewer sessions. These include hierarchies between the generations within a family, with semi-permeable boundaries permitting a sufficient flow of information up and down, for example between parents and their children. Specific behavioural change strategies, such as contingency contracting or operant conditioning, may be used. For example, providers without family therapy training would need to incur costs for this type of training and possibly costs for supervision over an extended period of time, which may deter some providers from pursuing the needed education to deliver these types of interventions. The team also observed that if the ‘identified patient’ improved, the family could become destabilised, seemingly resisting or blocking the clinical improvement of the patient – as if they needed the patient to remain unwell. The family was seen as a system with homeostatic tendencies and a variety of properties, such as hierarchies, boundaries, overt and covert conflicts between specific members, and coalitions. A social work student reading this text might be inclined to believe that individual and family therapy are quite distinct disciplines. This study has three aims in the provision of preliminary evidence to: 1) extend existing clinical recommendations; 2) define a general level of family involvement that is necessary for mothers to achieve a reduction in depressive symptoms; and 3) define the appropriate intervention dose in which families achieve intended outcomes. The various ingredients of family interventions include forming an alliance with the carers; lowering the emotional intra-family climate by reducing stress and burden on relatives; increasing the capacity of relatives to anticipate and solve problems; reducing the expressions of anger and guilt by family members; maintaining reasonable expectations for how the ill family member should perform; encouraging relatives to set appropriate limits while maintaining some degree of separatedness; and promoting desirable changes in the relatives' behaviours and belief systems (Reference Pharoah, Mari and StreinerPharoah et al, 2000). 3. These types of interventions range in prevention type from universal [37–38] to indicated [40]. de Roten, Yves Psychoeducational approaches (Reference Leff, Kuipers and BerkowitzLeff et al; 1982, Reference Anderson and McFarlaneAnderson 1983) combine behavioural interventions with structural techniques. This study, with an unusually long 2-year follow-up, is described in more detail below. We were unable to do the moderation analysis for the treatment studies because there were only two studies, which is too few for a moderation analysis. Detection bias involves the blinding of outcome assessors [56]. This finding in itself shows that drug treatment was far less acceptable to the patients in the study than was couple therapy. In fact, systemic therapy has been researched for a long time, with a whole range of studies of vastly differing quality conducted to evaluate its efficacy. Information was also sought about employment status; compliance of the family and the person with schizophrenia both with the family interventions and medication; mental state; moderation of family burden; and expressed emotion in the home. Other studies (Reference MartinMartin, 1985; Reference Herscovici and BayHerscovici & Bay, 1996) have replicated these results, with systemic family therapy being the main treatment, although used in combination with a mixture of individual and in-patient treatments. Reference Wilson, Fairburn, Nathan and GormanWilson & Fairburn, 1998; Reference CarrCarr, 2000a Another study was conducted by Dare et al (2001) to assess the effectiveness of specific psychotherapies, including family therapy. Patients continued to improve after the treatment had ended and preliminary data from the 5-year follow-up show that 75% have a good outcome, 15% an intermediate outcome and 10% have a poor outcome. Given the deleterious effects of perinatal depression on the family system [7, 9, 12], more research is needed on family therapeutic interventions that aim to prevent or treat perinatal depression. In the latter, adolescents were seen on their own and the parents were seen in a separate session by the same therapist. However, there appears to be no evidence that family intervention has significant effects on the ill person's social functioning. Data on the characteristics of the intervention group condition (e.g., intensity, types of systemic interventions experimental group model, number and length of sessions, duration of intervention, level of family member involvement) and control group conditions were extracted. For example, the woman with depression with low self-esteem may elicit her partner's over-protectiveness, a solution that perpetuates the presenting problem. The structure of businesses and the structure of families are very similar, considering the fact that so many businesses are owned or operated by families. It is important to recognise, however, that this may be, at least in part, owing to the lack of research on other treatments for this condition. Samantha K. J. Simpson, Jared M. Hawkins & Roy A Bean. Publication bias was not assessed since it can only be tested when a minimum of 10 studies are included in the meta-analysis to ensure there is adequate power to detect significant asymmetry [56]. Darwiche, Joëlle View all Google Scholar citations This approach is influencing many systemic therapists and has led to an examination of how language shapes problem perceptions and definitions. A wealth of data is now available and much of these are well summarised by Carr (2000a,b). In terms of general outcome at the end of the 1-year out-patient treatment and on 5-year follow-up (Reference Eisler, Dare and RussellEisler et al, 1997), the results were disappointing. Schweitzer, Jochen Second, we assess level of family involvement as a moderator of intervention impacts on maternal depressive symptoms. The current study shares four similar methods with the previously published systematic reviews and meta-analyses. One further small study used family therapy only (Reference DareDare, 1997) and approximately two-thirds of the patients made significant improvements or were recovered at follow-up. The likelihood of type one and type two errors increases as more subgroup analyses are performed [59] and for this reason, subgroup analyses were only conducted on a minimum of five studies to determine if hypothesized moderators strengthened intervention impacts on outcomes. Any uncertainties regarding the inclusion of articles were resolved by consensus between the content expert and an expert evaluator (second author). We used stratified analysis for study quality to assess discrepancies in results that were based on bias in the prevention studies and in the two treatment studies. No, Is the Subject Area "Metaanalysis" applicable to this article? Thus, the lack of available qualified providers may limit dissemination of these types of interventions. By the end of treatment more than 50% had reached a healthy weight, although most of the girls had not yet started menstruating again. Many of the most popular models during the period when family therapy flourished in the 1960s and 1970s directly incorporated systems theory. Behaviourally-inspired couple therapy approaches have been used for some time and have proved to be effective with patients suffering from depression. Seven studies were included in the qualitative and quantitative analyses. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. About 80% of the prevention studies targeted first-time parents and of these studies, and 75% of mothers were enrolled during pregnancy. We also included studies with measures of family functioning at baseline and at least one post-intervention time point. Render date: 2020-12-24T22:06:46.092Z https://doi.org/10.1371/journal.pone.0198730.g003. BEHER, STEFAN "openAccess": "0", At 1-year follow-up, approximately 75% had reached their target weight and 85% were menstruating. Box 2 Writing – original draft, Strategic family therapy is more effective for the female subjects than the male subjects. All of the prevention studies (n = 5) included in our review used family therapeutic interventions that were theoretically based in cognitive-behavioral models in the experimental groups. ‘Family’ is open to many interpretations, if not attacks, because it is frequently read as implying a two-parent, heterosexual couple with two children, with the woman primarily the ‘homemaker’ and the man the ‘breadwinner’, with occasional backup from the grandparents. PLoS ONE 13(6): Systemic family and couple therapy has also been shown to be effective in the treatment of eating disorders, psychotic illnesses and mood disorders. A total of 71% of studies [34–35, 37–39] were judged as low risk of attrition bias. here. Patients allocated to one of the treatments were not permitted to receive any other treatment simultaneously. The most recent Cochrane review (Pharaoh et al, 2000) found that 13 studies met its inclusion criteria (out of 69 citations). Some of the general goals of transition to parenthood programs are to facilitate healthy communication between parents, develop healthy family rules and limits, create shared responsibility in childrearing, and to teach parenting skills to increase positive behavior and prevent misbehavior in children [36–38]. A total of 86% [34–35, 37–39, 40] of studies were judged as low risk of reporting bias and one study [36] was judged as unclear. While one needs to acknowledge the potential for clashes between two very different epistemologies (Reference Asen, Berkowitz and CooklinAsen et al, 1991), most systemic therapists have now come to realise that their methods need to be shown to work if the field is to survive in the new evidence-base climate. First, the generalizability of our results may not be applicable to diverse populations. and Family therapy and systemic practice play a vital role in both adult and child and adolescent mental health in-patient services. Bowenian Family Therapy expert Dr. Philip Guerin discusses the origin and development of his family therapy theories and practices as well as his invention of the Genogram. "comments": true, and Query parameters: { 2009. von Sydow, Kirsten Family Therapy for Substance Use among Sexual Minority Youth: A Review of Treatment Options. Although most preventive psychotherapeutic interventions target only mothers with perinatal depressive symptoms [11], a growing awareness has developed regarding the importance of including the mothers’ adult family members in interventions that aim to reduce perinatal depressive symptoms [40]. I. It’s a whole new approach to understanding human behavior” (p. 3). Evidence-based medicine (Reference Sackett, Rosenberg and GraySackett et al, 1996) emphasises that appropriate treatments need to be matched with specific conditions, with outcomes being scientifically evaluated. For more information about PLOS Subject Areas, click These analyses did not produce any findings that indicated that the results were influenced by bias. The various parts of the system, the family members, were seen as behaving according to a set of explicit and implicit rules that govern interpersonal behaviours and communications (Reference Watzlawick, Jackson and BeavinWatzlawick et al, 1967). First, stigma prevents many women with perinatal depression from seeking treatment because they are afraid of the consequences (e.g., Child Protective Services might think the mother is “crazy” and remove the baby from her care) [66]. Relapse was defined in quite different ways, for example as the symptomatic deterioration of those patients who presented residual symptoms at baseline assessment, or as a recurrence of symptoms for patients with full remission at discharge. Data were extracted to assess risks of bias and study quality (see the “Qualitative analysis of study quality” subsection for details). One study used a psychoeducational model where partners were educated on perinatal depression and positive dyadic interaction was encouraged [49]. No, Is the Subject Area "Database searching" applicable to this article? Our study offers ample evidence to facilitate future research on family therapeutic interventions that aim to prevent or treat perinatal depression. Ryan, Larissa COFT appreciates a multidisciplinary approach, and welcomes manuscripts which address processes … This review poses the central research question: ZTo what extent, if any, is family and relationship therapy and psychotherapy effective? They are curated by JMFT's Virtual Issue Editors, Dr. Carissa D’Aniello and Dr. Megan Oka. Disagreements were resolved by consensus. Contemporary Family Therapy (COFT) is a quarterly, peer-reviewed publication that presents the latest developments in research, practice, theory, and training in couple and family therapy. Studies that included the mother (pregnant and postpartum up to six months) and at least one adult family member were included. Systemic couple therapy with patients with depression is only indicated if: c it is given together with antidepressant treatment, d the depressive illness is a first episode and of recent onset. Such a picture would seem to marginalise or exclude other family forms, such as childless couples, single parents with children, gay or lesbian couples and unattached elderly persons. For the maternal depressive symptoms, the overall findings for the meta-analysis that included all seven studies are presented in Fig 3. This important finding has led to a number of interventions aimed at reducing expressed emotion levels. The studies used a large number of outcome scales with the following being regarded as most relevant: Brief Psychiatric Rating Scale (Reference Overall and GorhamOverall & Gorham, 1962); Camberwell Family Interview (Reference Vaughn and LeffVaughn & Leff, 1976); Experience of Caregiving Inventory (Reference Szmukler, Burgess and HerrmanSzmukler et al, 1996); Global Assessment Scale (Reference Endicott, Spitzer and FleissEndicott et al, 1976); Present State Examination (Reference Wing, Cooper and SartoriusWing et al, 1974); and Ways of Coping (Reference MacCarthy, Kuipers and HurryMacCarthy et al, 1989). Better experience on our websites being at the couple-level, rather than the male.. By bias the presenting problem included cluster randomized trials, PDFs sent to google,! Has significant effects on the number of health care visits, especially for high utilizers study also. This analysis process data were extracted on the answers given by the same.. 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