Family therapy in the Czech Republic

Political, economic and cultural transformations in the Czech Republic after 1989 were reflected in a number of demographic indicators, including those that characterize family behaviour. The main features of these changes are declining birth and marriage rates, postponement of first marriage and first birth ages, and a growing proportion of children born outside of marriage. These changes are comparable to those that have taken place in western Europe since the 1960s; however, some of them are abrupt and cause rapid shift in the family structure. Over the last two decades, significant changes have also occurred in the organization of family therapy. Earlier less coordinated activities underwent institutionalization, and guidelines for training and supervision were established. Family therapy in the Czech Republic is covered by a national organization, the Society of Family Therapy (SOFT). Standards of training and supervision correspond to European standards. The problem remains the lack of support for family therapy from state institutions, especially in the health service. There are only a few healthcare facilities providing family therapy for the treatment of psychiatric disorders or chronic somatic diseases. The capacity of these centres is substantially inadequate.     

Attrition from Therapy Effectiveness Research Among Youth in a Clinical Service Setting

This study examined research attrition in clinical service settings by comparing psychotherapy research completers and dropouts in a private therapy practice. Seventy-seven children 7–12 years old enrolled in the Resilience Builder Program^® (RBP), a manualized group therapy created and administered in a private practice. Children had social impairments, and most were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and/or anxiety disorders. Results found that compared to completers, research dropouts had significantly greater social deficits, disruptive behavior problems, affective problems, medication use, and were more likely to be ethnic minorities. We discuss implications for research recruitment and retention in clinical service settings.     

University-Community Mental Health Center Collaboration: Encouraging the Dissemination of Empirically-Based Treatment and Practice

Community Mental Health Centers (CMHC) are valuable resources for urban youth and families across the nation. Community demands for high volumes of clinical service, however, often render these agencies without ability to fully evaluate provided services or conduct rigorous research with their target populations. This report asserts the importance of establishing effective collaborations between research-oriented universities and CMHCs in an effort to bridge the gap between empirically-based treatments and “real world” clinical practice. Furthermore, this report explains the establishment of a mutually informative and beneficial university-CMHC collaboration between the Disruptive Behavior Clinic at the University of Illinois-Chicago and the Community Mental Health Council (CMHC) on an evidence-based outpatient family therapy protocol for urban youth with behavior problems. Values and guidelines to facilitate evidence-based practice for fellow academic institutions are asserted. University-CMHC collaboration is an effective way to bring empirically-based practice to the “real world,” front-line practice settings of community-based agencies that serve urban youth. Further research with regard to the maintenance and sustainability of these collaborations is suggested.     

Predicting Prognosis for the Conduct-Problem Boy: Can Family History Help?

OBJECTIVE: Many children with conduct disorder develop life-course persistent antisocial behavior; however, other children exhibit childhood-limited or adolescence-limited conduct disorder symptoms and escape poor adult outcomes. Prospective prediction of long-term prognosis in pediatric and adolescent clinical settings is difficult. Improved prognosis prediction would support wise allocation of limited treatment resources. The purpose of this article is to evaluate whether family history of psychiatric disorder can statically predict long-term prognosis among conduct-problem children. METHOD: Participants were male members of the Dunedin Study, a birth cohort of 1,037 children (52% male). Conduct-problem subtypes were defined using prospective assessments between ages 7 and 26 years. Family history interviews assessed mental disorders for three generations: the participants' grandparents, parents, and siblings. RESULTS: Family history of externalizing disorders distinguished life-course persistent antisocial males from other conduct-problem children and added significant incremental validity beyond family and child risk factors. A simple three-item family history screen of maternal-reported alcohol abuse was associated with life-course persistent prognosis in our research setting and should be evaluated in clinical practice. CONCLUSIONS:: Family history of externalizing disorders distinguished between life-course persistent versus childhood-limited and adolescent-onset conduct problems. Brief family history questions may assist clinicians in pediatric settings to refine the diagnosis of conduct disorder and identify children who most need treatment.     

Family-based therapy for dementia caregivers: clinical observations

Family caregiving for dementia patients is a major social and clinical problem. Family caregivers face major stressful emotional, social and economic burdens, and the negative consequences associated with caregiving are well documented. Given the projected increase in the number of people with dementia, there is a need to identify approaches that will help families manage the challenges of caregiving. Social support from friends and family members has consistently been found to mediate caregiver outcomes, yet many caregivers face problems with isolation and estrangement from family members. In this regard, family-based therapy is a promising intervention for increasing social support for caregivers, and enhancing their quality of life and ability to provide care.This paper will discuss how family-based therapy can be applied as an intervention for family caregivers of dementia patients.The clinical implications of specific interactional patterns will be presented via case examples from an ongoing clinical trial with white American and Cuban American caregivers of dementia patients.The intent is to demonstrate how identification of interactional patterns is a valuable tool for implementing family-based interventions.     

Child and adolescent psychiatry and family therapy. An overview.

This article has provided an overview of the complex relationship between family therapy and child and adolescent psychiatry. Emphasis has been placed on the fact that the controversy and polarization that earlier characterized the relationship have delayed, but not blocked, the full integration of family therapy into child and adolescent psychiatry. Child psychiatrists and family therapists have been able to move beyond dichotomous polemics to combine the two fields in clinical practice, which has led to meaningful convergence in research and services. Family research has yielded important new directions for clinical practice in the areas of attachment, alcoholism, conduct disorder, and schizophrenia spectrum disorders. It also has led to models of family continuity that have considerable potential for interrelating and possibly integrating different family therapy models. Family research also has uncovered family factors in the intergenerational transmission of psychopathology that can inform clinical practice. Convergence in the clinical domain has led to improved assessment and treatment across a wide range of child, adolescent, and family developmental, emotional, behavioral, and mental disorders. Finally, this article has reviewed the controversy over family systems therapy and the development of new directions in theory and practice to which this controversy has led. Despite the possibility that these new directions might lead to significant disruption and interference in the process of convergence, careful examination of the controversy and the new developments in practice suggests that rather than producing division between the two fields, the new developments, especially narrative therapy, are more likely to bring the two fields closer, particularly in the realm of interventive interviewing in family therapy.     

The family in Romania: cultural and economic context and implications for treatment

The study of family structures, functioning, roles and values is fundamental in family therapist's activities for better understanding the psychological, cultural and social specificity of different clients and interventions. In this paper we describe the Romanian family and the family therapies which are available in Romania. We illustrate basic needs using demographic data and research available from Romania. The nuclear family remains dominant instead of other alternatives, the age of marriage is earlier than in western European countries and celibate and consensual living are exceptions or only for the transitional period before marriage. The role of marriage and childbirth within the marital setting is still important. The model of a single child appears increasingly common due to an improvement in financial resources and better living conditions. Relations with family of origin remain close. The difficulties for children with parents working in different countries raise problems and have implications for the extended family, educators and psychotherapists as well as mental health service providers. Family therapists should keep in mind the structure, function, role and values of the Romanian family for better understanding the issues and resources and use these accordingly in therapy. Policy-makers should be aware of the difficulties concerning availability and access to this therapeutic approach.     

Psychotherapy and the clinical social worker

Social work's long and historical involvement in psychotherapy has resulted in many significant contributions to practice such as the use of time, family and group therapy, the development of innovative settings and practices, and skill in using action communication. In addition, social workers have developed expertise in working with many that others have considered unsuitable for psychotherapy. Differences between psychiatric social work and the present more commonly used term, clinical social work, are related to issues of identity and autonomy, and essential practices and values that differentiate the clinical social worker from other professionals. These are a preference for the term client rather than patient, an emphasis upon person-in-situation, and a valued belief in client self-determination. However, special educational preparation is needed for the practice of psychotherapy which is considered a specialty within social work.     

Sense of Family Coherence in Parents of (Sub) Optimally Developing Children

The theoretical basis of the paper is Aron Antonovsky’s salutogenetic model of health, which is based on the salutogenic orientation and the sense of coherence understood as the central concept and the most important resource. The primary aim of the study is to determine the strength of the sense of family coherence in parents of optimally developing children and in parents of suboptimally developing children and their correlation with: family satisfaction and family orientation to crisis situations. The study was done using parents (N = 394) sampled from the population of the Republic of Serbia. Questionnaire for Obtaining Basic Data, The Family Sense of Coherence Scale, The Family Adaptation Scale and Family Crisis-oriented Scales were used for the purposes of this study. The findings of the study showed that parents of optimally developing children have a more heightened sense of family coherence than parents of suboptimally developing children. Also, the findings showed positive correlation with: family satisfaction and family orientation to crisis, and family sense of coherence. More precisely, the sense of family coherence in the parents who participated in the research correlates positively with satisfaction with one’s own family and family orientation to crisis.     

Perceptions of family relationships by institutionalized and noninstitutionalized dependent children

This paper reports research findings obtained regarding family relationships for three groups of adolescents: institutionalized, dependent children; noninstitutionalized, dependent children who are candidates for placement in institutions; and children living with their parents. It also describes a relatively novel, nonverbal, research instrument, the Family Relations Test, used to obtain the data. The conclusion is drawn that one of the major tasks of child care institutions is to restore children's self-esteem and confidence—yet it is far from certain as to whether these settings are capable of accomplishing this important task.This article was completed during the author's stay as Associate Professor at Cleveland State University, on leave from the School of Social Work at the Hebrew University of Jerusalem. He was formerly Director of the Department of Family and Community Services of the Jerusalem Municipality, is a founding member of ZAHAVI, the Association of Large Families in Israel, and is a member of the Secretariat of the Israel Association of Social Workers.     

Residential area and social contacts in schizophrenia

Background Social isolation is associated with poor prognosis in schizophrenia. We aim to determine the effect of rural or urban residence on frequency of social and family contacts. Method We analysed data from the European Schizophrenia Cohort, a two-year follow-up study of 1,208 patients in Britain, France and Germany. Frequency of contact was elicited with Lehman’s Quality of Life Inventory. Between-effect error component regression models adjusted the effects of living environment for country, age, gender, education, schizophrenia symptoms and global functioning. Results Across all living conditions, contact with family occurred more frequently than contact with others. Family visits, social visits and planned social activities were less common in urban compared to rural settings, whereas no significant differences were found for social and family telephone calls and time spent with a spouse. Patients living with a partner had more family, but fewer social contacts, while women had more contact by phone. Family and social contacts across all categories decreased with age. Employment increased social contacts, but did not affect visits or phone calls within the family. Schizophrenia symptoms, particularly negative symptoms, and impaired global functioning decreased all aspects of social and family contacts. Discussion Contrasting with results of previous studies, we found rural living was associated with greater frequency of social contacts in patients suffering from schizophrenia. Beyond living environment, our findings stress the importance both of an adequate control of negative symptoms and of employment opportunities for schizophrenia patients in order to enhance their social networks.     

Fundamentalism and the Search for Divinity: The Varied Role of Religion in Interfaith Couples

Religion has long been considered a crucial variable in marriage and family therapy research. Until recently, however, research on religious differences has not been specifically applied to clinical practice with interfaith couples. The importance of the rise in Fundamentalist values and their effects on interfaith couples has received far less attention. The purpose of this article is to describe how religious differences may be understood and experienced in a contemporary interfaith marriage. The ideas presented here aim to provide a glimpse into contemporary interfaith couples and a platform from which to explore broader themes of longing, surrender, and religious faith as they manifest in the couple dyad. Family clinicians are advised to carefully explore how religion operates in the lives of couples referred for treatment in relation to notions of romantic love, social support, and what is held sacred in the marriage. Clinical implications are provided for working with interfaith couples.     

Family therapy for eating disorders.

It is a perpetual source of debate whether dysfunctional family communication and relationship patterns cause eating disorders or the stress associated with raising a child with an eating disorder elicits such problems. Regardless, family therapy is a necessary component of any comprehensive biopsychosocial approach to the treatment of eating disorders. A careful assessment of the entire family, including the identified patient; his or her parents and siblings; the parents' marriage and families of origin; the child's emotional, social, and physical development; parental regulation of developmental stages; and communication patterns is mandatory. Family therapy for eating-disordered patients attempts to facilitate the elimination of potentially life-threatening symptoms and begin a therapeutic process of change within the entire family. Research has shown significant support for the use of family therapy in this population, but well-controlled treatment outcome research remains somewhat limited.     

State of psychiatry in Serbia - Problems, advances and perspectives

Abstract Serbia has been exposed to many severe stressors during the last 20 years and as a result there is an increase of the incidence of mental health problems in its population, so that mental disorders are the second largest public health problem, after cardiovascular diseases. The National Strategy for Development of Mental Health Care was approved by the government in January 2007 which initiated the reform of psychiatry in the country. The major advantages of the existing organization of mental healthcare are a sufficient number of psychiatric services and the number of well educated professionals, but there are considerable problems in big psychiatric hospitals which are significantly overcrowded with patients, as well as with the lack of a network of community services. In the future, key points of mental health reform aim to focus on improved cooperation and collaboration between primary, secondary and tertiary healthcare levels, definition of catchment areas and responsibilities, continuing education of general practitioners in mental health issues, and better cooperation between psychiatric and social welfare institutions. The profile of the Institute for Mental Health is described as a case of good practice in the field of mental healthcare in Serbia.     

The severely mentally ill: working better with specialist services

Abstract

The study of family structures, functioning, roles and values is fundamental in family therapist's activities for better understanding the psychological, cultural and social specificity of different clients and interventions. In this paper we describe the Romanian family and the family therapies which are available in Romania. We illustrate basic needs using demographic data and research available from Romania. The nuclear family remains dominant instead of other alternatives, the age of marriage is earlier than in western European countries and celibate and consensual living are exceptions or only for the transitional period before marriage. The role of marriage and childbirth within the marital setting is still important. The model of a single child appears increasingly common due to an improvement in financial resources and better living conditions. Relations with family of origin remain close. The difficulties for children with parents working in different countries raise problems and have implications for the extended family, educators and psychotherapists as well as mental health service providers. Family therapists should keep in mind the structure, function, role and values of the Romanian family for better understanding the issues and resources and use these accordingly in therapy. Policy-makers should be aware of the difficulties concerning availability and access to this therapeutic approach.     

DIZZYNET—a European network initiative for vertigo and balance research: visions and aims

Vertigo is one of the most common complaints in medicine. Despite its high prevalence, patients with vertigo often receive either inappropriate or inadequate treatment. The most important reasons for this deplorable situation are insufficient interdisciplinary cooperation, nonexistent standards in diagnostics and therapy, the relatively rare translations of basic science findings to clinical applications, and the scarcity of prospective controlled multicenter clinical trials. To overcome these problems, the German Center for Vertigo and Balance Disorders (DSGZ) started an initiative to establish a European Network for Vertigo and Balance Research called DIZZYNET. The central aim is to create a platform for collaboration and exchange among scientists, physicians, technicians, and physiotherapists in the fields of basic and translational research, clinical management, clinical trials, rehabilitation, and epidemiology. The network will also promote public awareness and help establish educational standards in the field. The DIZZYNET has the following objectives as regards structure and content:

• to focus on multidisciplinary translational research in vertigo and balance disorders,
• to develop interdisciplinary longitudinal and transversal networks for patient care by standardizing and personalizing the management of patients,
• to increase methodological competence by implementing common standards of practice and quality management,
• to internationalize the infrastructure for prospective multicenter clinical trials,
• to increase recruitment capacity for clinical trials,
• to create a common data base for patients with vertigo and balance disorders,
• to offer and promote attractive educational and career paths in a network of cooperating institutions.

In the long term, the DIZZYNET should serve as an internationally visible network for interdisciplinary and multiprofessional research on vertigo and balance disorders. It ideally should equally attract the afflicted patients and those managing their disorders. DIZZYNET will not compete with the traditional national or international societies active in the field, but will function as an additional structure that addresses some of the above problems.

     

Family unit therapy, the institution of the family and positive mental health.

Family unit therapy (F. U. T.) is conceptually differentiated from family member therapy (F. M. T). Clinical material is used to demonstrate the potential of F. U. T. for inducing positive-adaptive changes in the family, as a system, and in the functioning of its members, as related to Emotional Capital (EC), Autonomy (A), Self-Regulation (SR) and Competence (C). The implications of this experience and of some family research for social action are discussed. Questions are also raised about established and socially significant diagnostic and treatment practices, in dealing with emotionally and intellectually deprived children who are slow to develop.