Combining individual and family treatment: guidelines for the therapist.

Successfully combining individual and family treatment for psychosis-prone outpatients who live with their families is a process of keeping the needs of the patient and the family in balance. The therapist has to respond to each in an evenhanded way that preserves an alliance with both. Through guidelines and case reports, this chapter describes how to maintain that balance. The therapist-patient relationship is the core of treatment and keeps the clinician's focus squarely on the individual needs of the patient. In keeping with that focus, the therapist encourages self-determination on the patient's part and sets up opportunities for the family to communicate directly with the therapist in front of the patient, rather than surreptitiously behind the patient's back. In keeping with a collateral emphasis on the family, the therapist involves the family regularly and early in the course of treatment, respects the family's knowledge of the patient, puts that knowledge to use, and works with the family to deal promptly and effectively with incipient emergencies. The therapist knows that it is not only the therapist but also the family who stimulate a patient to change. The therapist, building on whatever strengths the patient and family possess, enlists the family as an ally in promoting and bringing about therapeutic progress.

Gender bias in families and its clinical implications for women.

Within the framework of feminist theory, this clinical study of 45 women with brothers explores family-based gender bias and elucidates its role in the lives of women. Bias is conceptualized along three dimensions: (1) devaluation--the woman perceives that she was less valued by her parents than a brother; (2) abuse without redress--the woman reports that she was abused by a brother and perceived herself as unable to get redress from her parents; and (3) deprivation--the woman perceives herself to have been deprived of resources or privileges that a brother had. The author identifies several legacies from the girlhood experience of gender bias that may be associated with depression in women: involvement in demeaning intimate relationships; self-doubt about competence in comparison with males; an isolating distrust of relationships; and the sacrifice of personal and relational development to serve parents and compensate for problematic brothers. Components of treatment are the therapist's self-awareness of internalized sexism; the questioning of client beliefs, based on sexist assumptions, that devalue women; and expanding women's perceived range of choice for improving their lives.

Combining individual and family treatment: guidelines for the therapist.

Successfully combining individual and family treatment for psychosis-prone outpatients who live with their families is a process of keeping the needs of the patient and the family in balance. The therapist has to respond to each in an even-handed way that preserves an alliance with both. Through guidelines and case reports, this chapter describes how to maintain that balance. The therapist-patient relationship is the core of treatment and keeps the clinician's focus squarely on the individual needs of the patient. In keeping with that focus, the therapist encourages self-determination on the patient's part and sets up opportunities for the family to communicate directly with the therapist in front of the patient, rather than surreptitiously behind the patient's back. In keeping with a collateral emphasis on the family, the therapist involves the family regularly and early in the course of treatment, respects the family's knowledge of the patient, puts that knowledge to use, and works with the family to deal promptly and effectively with incipient emergencies. The therapist knows that it is not only the therapist but also the family who stimulate a patient to change. The therapist, building on whatever strengths the patient and family possess, enlists the family as an ally in promoting and bringing about therapeutic progress.

Integrating individual and family treatment for outpatients vulnerable to psychosis.

Most clinicians favor family involvement in the treatment of adult outpatients who are at risk for major mental illness. New models for the family-oriented treatment of mental illness, particularly schizophreania, are, however, not readily adaptable to the situations encountered by practitioners working in clinics or private offices where one-to-one psychotherapy is the norm. This article describes a clinical model that is compatible with such an individualized outpatient practice (particularly for outpatients who are living with their family of origin or a spouse). The innovative feature of this model is the integration of the patient's family into the ongoing treatment on a regular basis, while continuing to maintain the primary focus on the patient and the therapist-patient relationship. To maintain a balanced response to the needs of both patient and family, prevent patient paranoia and family intrusiveness, and facilitate prompt and effective containment for patient losses of control, this model puts into place several mechanisms: (1) the scheduling of family meetings at predetermined times; (2) the establishment of protocol for handling unanticipated phone calls from family members; and (3) the creation of a three-way therapist-patient-family contract for dealing with incipient emergencies.

Service and patient predictors of continuation in clinic-based treatment.

The authors studied 125 chronic patients who entered treatment at five community mental health clinics to identify the patient and service predictors of continuation in treatment. Patients who remained in treatment at the end of one year were significantly more likely than those who dropped out to have received medication at early visits, to have participated in psychotherapy, and to be chronically psychotic. Analysis of the clinics that most successfully retained patients in treatment indicated that service characteristics rather than patient characteristics accounted for the clinics' success. The authors discuss the treatment programs at the two most successful clinics and the implications of the findings for community clinics.