Family therapy

These slides contain detailed description of family therapy including : Introduction, Definition, Aims/Goals, Indication, Contraindication, Functions, Types, Nursing diagnosis and interventions, Nursing responsibilities, Research.

1. FAMILY THERAPY PRESENTATION ON By Priyanshi

2. INTRODUCTION Family therapy is the branch of psychiatry which sees an individual’s psychiatric symptoms as inseparably related to the family in which he/she lives, thus the focus of treatment is not on the individual, but the family as whole. Family therapy is essentially about changing relationship through changing interaction among people who make up the family. The basic principle of family therapy evaluate the complex web of relationship pattern of transaction taking place within a family system.

3. DEFINITION “A psychotherapeutic approach that focuses on interaction between a couple within a nuclear family or its members in extended family or between the family and other interpersonal systems with the goal of alleviating problems initially presented by individual family members, family subsystem, the family as a whole or other referral sources.”

4. AIMS/GOALS To reduce dysfunctional behaviour of individual family members. To reduce conflicts in family relations. To improve family communication skills. To heighten awareness and sensitivity to other family members to meet their needs.

5. To strengthen family’s ability to cope with major life stressors and traumatic events. To improve integration of family system into social system. To improve autonomy for each member. To reduce distress in the patient.

6. INDICATION Problem in relationship within the family Interdependence of symptoms Failure of individual therapy Psychosis Schizophrenia Childhood psychiatric disorder Anxiety disorder Bipolar disorder

7. CONTRAINDICATION Family in the process of breaking up. Family in which tense, dysfunctional equilibrium is present. Families staying apart. Non-availability of key family members. Families in which members are unwilling to take therapy.

8. FUNCTIONS OF FAMILY THERAPY

9. MANAGEMENT FUNCTIONS : Decision-making, rule-making, provision of financial support. In a healthy family, usually adults take these decisions and they see that children learn decision making skills as they mature and prefer to make choices on their own lives . BOUNDARY FUNCTIONS : Boundary maintain distinction between individuals in family, They may be Clear Boundaries : are usually well understand by all members, helps define their roles in family. Diffuse Boundaries : refers to blending together of roles, thoughts and feelings. Clear distinctions may fail to emerge. Rigid Boundaries : in families where this predominates, isolation may be marked. The family can often get cut-off from community.

10. COMMUNICATION FUNCTION : Extremely important in family life, encourages members to express their feelings and prevent conflicts. EMOTIONAL-SUPPORTIVE FUNCTION : Healthy family is concerned with each others need and provide emotional support to the family members at the time of crisis. Gives freedom to grow, explore new roles within family members. SOCIALISATION FUNCTION : It is within the family that each member learns socialisation skills, learn how to interact, negotiate and plan. They also adopt coping skills. Promotes safety, security and lays emphasis on kinship patterns. Decreases the chances of social tension and conflicts with society.

11. TYPES OF FAMILY THERAPY 1. INDIVIDUAL FAMILY THERAPY : In individual family therapy, each family member has a single therapist. The whole family may meet occasionally with one or two of the therapists to see how the member’s are relating to one another and work out specific issues that have been defined by the individual members.

12. 2. CONJOINED FAMILY THERAPY : The most common type of family therapy is the single-family or nuclear family therapy. The family is seen, and the issues and problems raised by the family are addressed by the therapist. The way in which the family interacts is observed and becomes the focus of therapy. The therapist helps the family deal more effectively with problems as defined.

13. 3. MULTIPLE FAMILY GROUP THERAPY : In this therapy, four or five families meet weekly to confront and deal with the problems or issues they have in common. Ability or inability to function well in the home and community fearing of talking to or relating to others, abuse, anger, neglect, the development of social skills, and responsibility for oneself are some of the issues on which these group focus and become the support for all the families.

14. 4. MULTIPLE IMPACT THERAPY : Several therapists come together with families in a community setting. They live together and deal with pertinent issues for each family member within the context of the group. Multiple impact therapy is similar to multiple family group therapy except that it is more intense and time limited. Like multiple family group therapy, it focuses on developing skills or working together as a family and with other families.

15. 5. NETWORK THERAPY : It is conducted in people’s homes. All individuals interested or invested in a problem or crisis that particular person or persons in a family are experiencing take part in therapy. This gathering includes family, friends, neighbours, professional groups or persons. People who form the network generally know each other and interact on a regular basis in each other’s lives. Thus a network may include as many as 40 to 60 people.

16. 6. MARITAL/COUPLE THERAPY : Couples are often seen by the therapist together. The couple may be experiencing difficulties in their marriage, and in therapy, they are helped to work together to seek a resolution for their problems, family patterns, interaction and the communication styles, each partner’s goals, hopes and expectations are examined in therapy. This examination enables the couple to find a common ground for resolving conflicts by recognizing and respecting each other’s similarities and differences.

17. OBJECTIVE OF MARITAL THERAPY A support of marriage/couple in identifying sources of conflict. A help to each partner in determining their participation in conflicts. A help in deciding whether to continue the relationship or not. An improvement in natural verbal communication and non-verbal communication.

18. INDICATIONS OF MARITAL THERAPY Overprotection of one partner co-existing with emotional dependence of others. Jealousy combined with controlled suspicion and restriction. Dominance of one partner with lowering self esteem of other. Mutual antagonism blaming an emotional interdependence.

19. CONTRAINDICATIONS OF MARITAL THERAPY Physical violence between partners. Mental illness or addiction problem of one or both partners. Staying of partners in other relationship and lack of motivation to give up on them. Undertaking the decision of divorce.

20. NURSING DIAGNOSIS AND INTERVENTIONS

21. 1. Impaired parenting related to ineffective role-modelling as evidenced by lack of parental attachment behaviour. Asses parents of developmental task of self and understanding of child’s growth and development. Provide an opportunity for parents to express their feelings needs and goals. Praise the parents for their participation in child’s care. Include the parents in planning and care and setting goals.

22. 2. Ineffective therapeutic regimen management complexity of healthcare as evidenced by verbalised difficulty with prescribed regimen . Assess for related circumstances that may negatively influence resolution. Evaluate the parents conviction on his/her ability to perform desired behaviour. Inform patient of benefits of adherence to prescribed regimen. Include the patient in planning the treatment regimen.

23. 3. Ineffective coping related confusion in pattern of appraisal of threat or tension release as evidenced by inability to meet role expectation. Assess for influence of cultural beliefs, norms and values on the patient’s perception of effective coping. Observe the causes for ineffective coping such as poor self concept, grief, lack of problem solving skills, etc. Observe for strength such as ability to relate to the facts and acknowledge source of stressors. Monitor risk for harming self or others and work appropriately.

24. 4. Knowledge deficit related to emotional state affecting learning as evidenced by verbalization inaccurate information / incorrect task performance . Assess the ability to perform desired health related care. Identify priority of learning needs within the overall plan of care. Allow learner to identify what is most important to him/her. Explore attitudes and feelings about change. Allow for self support ,self directed and self designed learning.

25. NURSING RESPONSIBILITIES Create a therapeutic environment that foster trust and make member fully safe and comfortable. Promote effective communication by seeking clarification or vague statements. Identifying patterns of interaction that interfere with successful problem solving. Help the family to identify problems that demand change. Encourage all members to express honest feeling without judgement .

26. Avoid being triangled in family’s emotional system. Remain natural and objective. Reframe problems into their resolutions. Discuss present coping strategies encourage each member to describe how they cope with stress. Identify community resources that may assist members to adapt coping mechanisms. Assist family members in planning leisure time activities together and encourage ‘we-feeling’.

27. RESEARCH

28. An analysis of available evidence published in 2005 concluded that family therapy is now an empirically supported therapy . It clearly works both in general and for a variety of specific problems. 2019 review of research listed the following circumstances in which family therapy has proven to be effective, these are: Problem in infancy like sleep, feeding and attachment. Child abuse and neglect, conduct problems and delinquency. Emotional problem including anxiety, depression, grief, bipolar disorder, suicidal tendencies. Drug abuse/ Substance abuse. Eating disorders including anorexia nervosa, bulimia nervosa and obesity. Adjustment to chronic physical illness.