Group, Family, Couples Interventions

1
Group, Family, Couples Interventions

• Logistical, practical aspects first (because
  group interventions formats are more uniform
  than their theories)
• A bit about theories behind group, family/
  couples interventions
• Research evidence on outcomes

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Group Therapies

• Common format, varying theories
• 512 members
• Lasts weeks to years
• Open or closed membership panel
• Closed format works best for time-limited groups
• Frequency of meetings varies (generally from
  every other week, to 2?/week)
• Often use a co-therapist

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Theories

• Individual treatment in group
• Psychodynamic
• Client-centered
• Gestalt therapy
• Behavioral, etc.
• Group dynamics orientation
• Whitaker Lieberman

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Theories, contd

• Yaloms curative factors (from patient surveys)
• Instillation of hope
• Universality
• Imparting Information
• Altruism
• Corrective Recapitulation of Primary Family Group
• Development of Socializing Techniques
• Imitative Behavior

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Outcome Data

• Smith, Glass Miller meta-analysis across
  studies (1 study has individual, another has
  group), they work quite equally well
• Head-to-head studies produce about the same
  result overall equality in outcomes
• Economics favor group therapy

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Family Therapy

• Can involve even extended family (e.g.,
  grandparents)
• Conducted under various theories
• Systems theory
• Psychoeducational
• Behavioral

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Systems Theory

• All family members are part of interacting
  system. Identified patient may not be locus of
  problem. You cant change one without changing
  others, so dont try.
• Dysfunctional roles (e.g., black sheep)
• Mis-alliances (e.g., across generations)
• Secrets (dont tell) and secret rules (double
  bind)

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Psychoeducational Approach Schizophrenia

• Family interactions affect relapse rate in
  schizophrenia demeaning comments (expressed
  emotion)
• Some relatives attribute dysfunctional behavior
  not to illness, but to laziness, etc.
• Educate family, lessen expectations, work on more
  positive interactions

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Behavioral Parent Training

• Identify problem child behaviors
• Identify situational antecedents, reinforcers
• Train parents in
• Target behavior monitoring
• Target behavior shaping via reinforcement, etc.
• Consistency!

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Family Therapy Effectiveness

• Few studies examine family therapy of systems
  variety 3 studies, 2 positive in teenagers, both
  for treating substance abuse
• Behavioral has a number of studies supporting it
• Psychoeducational for schizophrenia has over 40
  studies, fair to good results so far

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Couples Therapy (per Jacobson)

• Can be based on systems, communication, or
  behavioral principles (among others)
• All methods appear to work better than doing
  nothing
• All have meager results in terms of objective
  outcomes (e.g., divorce rate)
• All methods studied apparently work about equally
  well