What Are the Theoretical Approaches in Marriage and Family Therapy Peer Review

Indian J Psychiatry. 2018 Feb; 60(Suppl 4): S501–S505.

Marital and family therapy

Hargun Ahluwalia

Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India

Tanya Anand

Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India

L.North. Suman

Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India

Abstract

Substance corruption is a family illness that adversely impacts both the user and the user'due south family. The family unit can human activity equally a take a chance factor for the development of substance abuse among children and adults. The family unit can also be involved in therapy to either assist the recovery process or prevent substance abuse. Marital and family therapy have been establish to be effective in reducing the severity of substance use, lowering marital and family unit conflict, improving family communication and cohesion too equally effective parenting practices. Behavioural Couples Therapy has been found to take skilful empirical back up for bringing about the desired changes in both substance abuse and marital relationship. While targeting entire families, the most common evidenced based family unit interventions are Brief Strategic Family Therapy, Multidimensional Family unit Therapy, Family Behaviour Therapy, Functional Family Therapy and Customs Reinforcement Programme. Marital and family unit therapy have to be sensitive to gender and culture. Constructive use of marital and family therapy requires acceptable training to equip practitioners in fairly treating non only substance employ disorders and family pathology, but also in treating co-morbid mental health conditions.

Keywords: Substance abuse, Marital therapy, Family therapy, Boyhood, Prevention

INTRODUCTION

The focus of family therapy treatment is to intervene in complex relational patterns and to alter them in ways that bring about productive alter for the entire family. Family therapy rests on the systems perspective, which proposes that changes in one office of the system tin can and do produce changes in other parts of the arrangement, and these changes tin contribute to solutions. Family unit therapy in substance abuse treatment has two principal purposes. First, it seeks to utilise the family's strengths and resource to aid find or develop ways to live without substances of abuse. 2d, information technology reduces the impact of chemical dependency on both the patient and the family unit. In family unit therapy, the focus of handling is the family unit, and/or the individual inside the context of the family system. The person abusing substances is regarded equally a subsystem within the family unit—the person whose symptoms have astringent repercussions throughout the family unit organisation. The familial relationships within this subsystem are the points of therapeutic interest and intervention¹.

Family unit is a key resources in the care of patients in India as its civilisation of inter-dependence gives the family unit a pre-eminent status. Psychoactive substance corruption and dependence has a meaning deleterious impact on the family of the substance user. This bear upon can so atomic number 82 to a chain of events which can not only screw out of control but too spiral downward. In a study carried out in India², family burden was found to be moderate to severe in families with a substance dependent person. The burden was characterized by disruption of family unit interactions, disruption of family routine, disruption of family unit leisure and financial burden. Co-ordinate to Kumferⁱⁱⁱ, since substance abuse is a 'family illness' of lifestyle, including both genetic and family environmental causes, effective family strengthening prevention programmes should be included in all comprehensive substance abuse prevention activities.

THEORETICAL BACKGROUND

Studies carried out in the Indian setting accept indicated that alcohol dependence in men is linked to marital dissatisfaction^iv and domestic violence⁵, psychological distress amongst their sons⁶ and poor parenting practices by the alcohol dependents⁷. Further, booze dependence in men has been implicated in family disintegration^eight, forcing spouses of alcohol dependents with poor support systems to seek refuge in shelter homes⁹ and contributing to adverse childhood experiences in the lives of their children¹⁰. In addition, family substance abuse is a adventure cistron for children to develop substance use disorders through interplay of genetic and environmental factors. For instance, parental substance utilize has been associated with positive expectancies from the substances among their children^eleven This familial gamble factor has been implicated in pathways to substance abuse amongst women as well¹².

Autonomously from the damage caused to the spouses and children due to substance abuse amongst men, substance corruption among adolescents and young adults has been associated with parental distress and stress¹³. Information technology must be noted that the family can play an of import part in preventing substance use amongst adolescents through maintaining close ties, providing care and nurturance and ensuring adequate monitoring and supervision. The family can likewise ensure a substance costless lifestyle past conforming to social norms and practicing religiosity/spirituality¹⁴. It has been found that adolescents also perceive a need for parental guidance and family support in their journey of recovery from substance abuse¹⁵.

It is evident that the family can exist a risk factor besides as a protective factor. Additionally, the family can facilitate recovery or impede recovery. The acute clinician has to examine diverse strands of family operation to determine what aspects have to be strengthened, altered or reduced in order to improve the effectiveness of the approach. These clinical decisions volition be informed by the unique features in a given example, making the therapy individually tailored. Thus, empirical literature indicates that clinicians providing interventions for substance dependence should give as much attention to the family unit as they would requite to the patient.

CLINICAL APPLICATIONS

Couple Therapy

Couples therapy has been institute to be an efficacious handling for persons with substance apply issues. Therapy programmes which have included spouses accept been establish to exist constructive in motivating patients to enter and keep handling. They have also been associated with better outcomes in treatment such every bit lower substance use, longer periods of abstinence and meliorate marital functioning. The theoretical framework underlying couples therapy is an understanding of substance employ and marital discord as being cyclic. Problems in the marital relationship, poor communication and poor problem solving may precede harmful use of substances, and dysfunctional relationships can maintain and facilitate the substance use. Marital and family conflicts also accept the propensity to facilitate relapse¹⁶. In a critique of 41 unlike treatments for alcohol problems, Behavioural Couples Therapy (BCT) was constitute to be the simply type of family intervention and one of 16 therapies to have adequate empirical support for effectiveness¹⁷. Hence, the National Establish of Clinical Excellence Guidelines recommends BCT for individuals with harmful drinking and alcohol dependence¹⁸.

In BCT, the patient and spouse are typically seen together in 12-20 weekly outpatient sessions over a 3-six month period. BCT can exist an offshoot to other psychotherapeutic interventions or the mainstay in therapy. Indications for BCT are: availability of both partners for sessions; couples that are married or cohabiting at to the lowest degree for the last i year; one member with substance use problems. Contraindications for BCT are: couple ordered by courtroom to have no contact with each other; gross cognitive impairment or psychosis; severe concrete aggression; when both spouses have substance use issues. The intervention is aimed at two goals – substance use recovery and enhanced relationship performance. Substance use recovery is addressed first with the therapist understanding the patterns of substance use and interactions in the marital dyad¹⁹. This is indicated in Figure 1:

Wheel of treatment components of BCT

Human relationship focused interventions are introduced once the patient has maintained forbearance and the couple is regular to sessions. The major goals of this role of the handling are to enhance positive feelings, communication skills and problem solving. Communication skills include listening skills, expressing emotions straight and negotiation skill

Family Therapy

The focus of substance abuse treatment worldwide is shifting from cosmetic to a preventive arroyo. This is due to the fact that the historic period of developing substance related problems is reducing and impacting the youth. Constructive treatment for adolescents is suggested to exist one that brings nearly change in various domains of a young individual's life and context. This necessitates family unit therapy and combined family unit and community based interventions for boyish substance corruption. The therapist and the family should be equal participants in the therapeutic procedure. Including adolescents' parents into any treatment programme increases the likelihood of handling adherence and compliance. As a result, family involvement and mail service handling support facilitate successful outcomes in treatment of adolescent substance abuse^xx.

The term 'Family Based Interventions' is used to draw a collection of intervention models that focus on family unit communication, cohesion, conflict and parenting practices. The nearly common evidenced based family interventions are Brief Strategic Family Therapy, Multidimensional Family Therapy, Family Behaviour Therapy, Functional Family Therapy and Community Reinforcement Programme. The goals of these interventions are to bring about systemic changes, skills building, enhancing positive family and social activities, improving communication, problem solving and making non-substance employ rewarding²¹. These interventions have shown amend outcomes in terms of reduction in substance use, improved family relations, better work outcomes, adherence to treatment, treatment memory and long- term maintenance of gains²².

Gender and civilization are likewise meaning in planning or developing a therapy that aims to change the firsthand social and cultural environment of the boyish. For instance, abuse, abandonment and low are key issues that must be addressed for girls with substance use disorders in handling. Trauma models of substance abuse among girls and women bespeak the demand to make their family environments safer and healthier. Such gender sensitivity and targeting of frail issues are very therapeutic and are key factors in reducing self-harm behaviours amid girls and immature women. Family interventions also effectively reduce intimate partner violence and thereby reduce kid exposure to domestic violence (CEDV). The greater stigma attached to substance abuse amid girls and women can also exist addressed in family unit therapy in gild to reduce feelings of shame and guilt²³. In add-on, the professional treating a patient and family cannot overlook the cultural background that the patient's family unit comes from. Being culturally sensitive necessarily does not hateful that the therapist must belong to the culture, but rather that they have developed sensitivity to the civilization by gaining noesis, observing and paying attention to diverse behaviours and dynamics and is ready to learn from the patients and their families. The therapist should understand how cultural differences influence substance abuse, health beliefs, help-seeking behaviour and perceptions of behavioural health services²⁴.

Table i

Components of Human relationship Promises

Tabular array 2

Increasing Positive Exchanges

The family also plays an important role in prevention of substance employ and evidence-based interventions for preventing substance utilize disorders include programs such equally 'Family unit Matters', 'Creating Lasting Family unit Connections' and 'Brief Strategic Family unit Therapy'. 'Family unit Matters' is a universal prevention programme that enables families to identity and address family characteristics, behaviours, and attitudes that tin can influence adolescent substance apply. These include levels of developed supervision and support; family unit rule-setting and communication; family time spent together; parental monitoring; family unit/adult substance use; the availability of substances; and social attitudes most substance utilise in the media and amongst peers. 'Creating Lasting Family Connections' is a selective programme designed for youth and families in high-run a risk environments that focus on substance utilise issues, personal and family responsibilities, and advice and refusal skills. 'Brief Strategic Family Therapy' is an indicated programme designed for families in which children and adolescents exhibit early substance use, rebelliousness, and/or delinquency. This approach strives to increase and reinforce competent family interactions and behaviours through shifting interpersonal boundaries equally needed, building conflict resolution skills, and providing parental coaching²⁵.

Family engagement tin can range over various modalities, such as telephonic conversations, video sessions, counselling groups, family sessions where the adolescent-family interaction is observed as well as separate sessions with parents, addressing focused upon issues to raise treatment outcome. Therapy motivations of the parents and family unit therapy with single parent families are problems that must be clinically assessed and addressed not but before initiating therapeutic contact, but as well during the intervention²⁶. Farther, parents' own substance use difficulties, quality of marital relationship and mental health must be assessed and addressed if required to reduce dysfunction in the family and improve family atmosphere²⁷. Information technology is advisable to see the family unit members separately in individual sessions in order to get pertinent data. Some disclosures may exist made merely to the therapist and the other family members may be unaware of the disclosed information. It is important for the therapist to maintain privacy and confidentiality regarding such 'family secrets' within the boundaries of ethical guidelines and legal directives. It is also of import for the therapist to be objective and non to take sides of any one family member or a dyad.

Therapist's grooming and experience is mandatory before trying out any intervention. Therapists must be experienced in family therapy skills, and should accept had preparation in individual therapy. Ideally, the therapist must exist knowledgeable about family therapy practices as well as substance corruption handling practices. Family unit therapists who wish to treat substance corruption must get themselves informed about basic substance related issues besides as substance corruption handling processes. This may include screening and assessment of substance utilise, motivational enhancement techniques, relapse prevention, also as training in specific models of therapy, for e.g. Cognitive Behavioural Therapy for substance abuse or Dialectical Behaviour Therapy for co-morbid substance dependence and emotionally unstable personality. Recently²⁸, information technology has been recommended that integrated interventions be used for co-occurring substance use disorders and other psychiatric disorders rather than treating only substance abuse or treating simply the co-occurring disorder. This approach will necessitate the availability of experienced clinicians and therapists and training will exist required to equip practitioners in adequately treating the conditions.

Summary and Future Directions

Substance abuse has a tremendous impact on not only the user simply also on the user's family. The family can be a gamble factor for substance abuse or it tin act as an important resource for recovery from substance abuse. Marital and family therapy for substance abuse have been constitute to be efficacious for men, women and adolescents. Family interventions have too been successfully used to prevent substance misuse. Considering the sheer number of individuals with substance abuse problems in India, effective treatments such every bit marital and family therapy should exist regularly offered to patients and their family members whenever indicated. This would require tremendous and sustained efforts to railroad train a large number of mental health professionals in these therapy modalities. Autonomously from ensuring that quality care is provided, it is also important to make the therapies attainable and affordable. In club to maintain contact with the therapist, feasible and affordable technology driven tools such as mobile messaging and apps, and therapy sessions using the net can exist employed. Dedicated programmes that involve the family and community are also required to preclude substance abuse among children and adolescents. These psychosocial interventions are vital for a country similar Bharat with its emphasis on family oriented living.

Financial back up and sponsorship

Nil.

Conflicts of interest

At that place are no conflicts of involvement.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844162/

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