Peer Review Articles on Role of Marriage and Family Therapist
Indian J Psychiatry. 2018 Feb; 60(Suppl 4): S501–S505.
Marital and family unit therapy
Hargun Ahluwalia
Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
Tanya Anand
Section of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
L.N. Suman
Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
Abstract
Substance abuse is a family illness that adversely impacts both the user and the user'southward family. The family can human activity as a risk factor for the development of substance abuse amidst children and adults. The family tin can too exist involved in therapy to either help the recovery process or prevent substance abuse. Marital and family unit therapy have been found to be effective in reducing the severity of substance use, lowering marital and family unit conflict, improving family communication and cohesion as well as effective parenting practices. Behavioural Couples Therapy has been found to accept adept empirical support for bringing near the desired changes in both substance abuse and marital relationship. While targeting entire families, the most mutual evidenced based family unit interventions are Brief Strategic Family Therapy, Multidimensional Family Therapy, Family Behaviour Therapy, Functional Family Therapy and Community Reinforcement Plan. Marital and family therapy have to exist sensitive to gender and culture. Constructive use of marital and family therapy requires adequate training to equip practitioners in adequately treating not only substance use disorders and family unit pathology, only as well in treating co-morbid mental wellness conditions.
Keywords: Substance abuse, Marital therapy, Family therapy, Adolescence, Prevention
INTRODUCTION
The focus of family unit therapy treatment is to intervene in circuitous relational patterns and to alter them in ways that bring about productive change for the entire family. Family therapy rests on the systems perspective, which proposes that changes in one part of the system can and do produce changes in other parts of the system, and these changes tin can contribute to solutions. Family therapy in substance corruption treatment has two main purposes. Kickoff, it seeks to use the family unit's strengths and resources to assistance detect or develop ways to live without substances of abuse. 2d, it reduces the impact of chemic dependency on both the patient and the family. In family therapy, the focus of treatment is the family, and/or the private within the context of the family organization. The person abusing substances is regarded as a subsystem within the family unit—the person whose symptoms take astringent repercussions throughout the family organization. The familial relationships within this subsystem are the points of therapeutic interest and interventionone.
Family is a fundamental resource in the care of patients in Republic of india equally its civilisation of inter-dependence gives the family a pre-eminent status. Psychoactive substance abuse and dependence has a significant deleterious impact on the family unit of the substance user. This impact can then lead to a chain of events which can not just spiral out of control but also screw downward. In a study carried out in Indiatwo, family unit brunt was found to be moderate to astringent in families with a substance dependent person. The burden was characterized by disruption of family unit interactions, disruption of family unit routine, disruption of family leisure and fiscal burden. According to Kumfer3, since substance corruption is a 'family illness' of lifestyle, including both genetic and family environmental causes, effective family strengthening prevention programmes should exist included in all comprehensive substance abuse prevention activities.
THEORETICAL Groundwork
Studies carried out in the Indian setting have indicated that booze dependence in men is linked to marital dissatisfactioniv and domestic violence5, psychological distress amidst their sons6 and poor parenting practices past the alcohol dependents7. Farther, booze dependence in men has been implicated in family disintegration8, forcing spouses of booze dependents with poor support systems to seek refuge in shelter homes9 and contributing to agin childhood experiences in the lives of their children10. In addition, family unit substance corruption is a risk gene for children to develop substance use disorders through interplay of genetic and environmental factors. For instance, parental substance use has been associated with positive expectancies from the substances among their childreneleven This familial gamble factor has been implicated in pathways to substance abuse among women as well12.
Apart from the harm caused to the spouses and children due to substance abuse among men, substance corruption amongst adolescents and young adults has been associated with parental distress and stress13. It must be noted that the family can play an of import role in preventing substance use amid adolescents through maintaining close ties, providing intendance and nurturance and ensuring acceptable monitoring and supervision. The family can also ensure a substance complimentary lifestyle by befitting to social norms and practicing religiosity/spirituality14. It has been found that adolescents also perceive a demand for parental guidance and family unit support in their journey of recovery from substance abusefifteen.
It is evident that the family unit tin can exist a risk factor equally well equally a protective cistron. Additionally, the family tin can facilitate recovery or impede recovery. The astute clinician has to examine various strands of family functioning to determine what aspects have to exist strengthened, altered or reduced in social club to improve the effectiveness of the approach. These clinical decisions will be informed by the unique features in a given case, making the therapy individually tailored. Thus, empirical literature indicates that clinicians providing interventions for substance dependence should give as much attention to the family equally they would give to the patient.
CLINICAL APPLICATIONS
Couple Therapy
Couples therapy has been found to be an efficacious treatment for persons with substance use problems. Therapy programmes which take included spouses accept been plant to be constructive in motivating patients to enter and continue handling. They have also been associated with amend outcomes in handling such as lower substance use, longer periods of abstinence and improve marital performance. The theoretical framework underlying couples therapy is an understanding of substance use and marital discord as being cyclic. Problems in the marital relationship, poor advice and poor problem solving may precede harmful use of substances, and dysfunctional relationships can maintain and facilitate the substance use. Marital and family unit conflicts as well have the propensity to facilitate relapsexvi. In a critique of 41 different treatments for booze issues, Behavioural Couples Therapy (BCT) was found to exist the merely type of family intervention and 1 of 16 therapies to have acceptable empirical support for effectiveness17. Hence, the National Establish of Clinical Excellence Guidelines recommends BCT for individuals with harmful drinking and alcohol dependencexviii.
In BCT, the patient and spouse are typically seen together in 12-20 weekly outpatient sessions over a iii-half-dozen month period. BCT tin can exist an adjunct 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 least for the concluding 1 year; one member with substance use problems. Contraindications for BCT are: couple ordered by court to have no contact with each other; gross cerebral impairment or psychosis; severe physical aggression; when both spouses have substance use problems. The intervention is aimed at two goals – substance use recovery and enhanced relationship operation. Substance use recovery is addressed first with the therapist agreement the patterns of substance use and interactions in the marital dyad19. This is indicated in Effigy 1:
Bike of handling components of BCT
Relationship focused interventions are introduced once the patient has maintained abstinence and the couple is regular to sessions. The major goals of this part of the treatment are to enhance positive feelings, communication skills and problem solving. Communication skills include listening skills, expressing emotions directly and negotiation skill
Family Therapy
The focus of substance abuse treatment worldwide is shifting from corrective to a preventive approach. This is due to the fact that the age of developing substance related bug is reducing and impacting the youth. Effective handling for adolescents is suggested to be ane that brings nigh change in diverse domains of a immature individual's life and context. This necessitates family therapy and combined family and customs based interventions for adolescent substance corruption. The therapist and the family should be equal participants in the therapeutic process. Including adolescents' parents into any treatment programme increases the likelihood of treatment adherence and compliance. As a result, family involvement and post treatment support facilitate successful outcomes in treatment of boyish substance corruptiontwenty.
The term 'Family Based Interventions' is used to describe a collection of intervention models that focus on family unit communication, cohesion, conflict and parenting practices. The virtually common evidenced based family interventions are Cursory Strategic Family unit 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 use rewarding21. These interventions have shown better outcomes in terms of reduction in substance utilise, improved family relations, meliorate work outcomes, adherence to treatment, treatment retention and long- term maintenance of gains22.
Gender and civilization are also significant in planning or developing a therapy that aims to modify the immediate social and cultural environment of the adolescent. For instance, corruption, abandonment and depression are fundamental issues that must be addressed for girls with substance use disorders in treatment. Trauma models of substance corruption amongst girls and women indicate the need to make their family unit environments safer and healthier. Such gender sensitivity and targeting of delicate bug are very therapeutic and are key factors in reducing cocky-damage behaviours among girls and young women. Family interventions also effectively reduce intimate partner violence and thereby reduce child exposure to domestic violence (CEDV). The greater stigma fastened to substance abuse amidst girls and women can also be addressed in family unit therapy in order to reduce feelings of shame and guilt23. In addition, the professional treating a patient and family unit cannot overlook the cultural groundwork that the patient'southward family comes from. Being culturally sensitive necessarily does not mean that the therapist must vest to the culture, only rather that they take adult sensitivity to the culture by gaining knowledge, observing and paying attention to various behaviours and dynamics and is ready to learn from the patients and their families. The therapist should sympathize how cultural differences influence substance abuse, health beliefs, help-seeking behaviour and perceptions of behavioural health services24.
Table ane
Components of Relationship Promises
Table 2
Increasing Positive Exchanges
The family also plays an important role in prevention of substance use and evidence-based interventions for preventing substance utilise disorders include programs such equally 'Family Matters', 'Creating Lasting Family unit Connections' and 'Brief Strategic Family unit Therapy'. 'Family Matters' is a universal prevention programme that enables families to identity and accost family unit characteristics, behaviours, and attitudes that tin can influence adolescent substance use. These include levels of developed supervision and support; family dominion-setting and communication; family unit fourth dimension spent together; parental monitoring; family unit/adult substance apply; the availability of substances; and social attitudes nigh substance use in the media and among peers. 'Creating Lasting Family Connections' is a selective program designed for youth and families in high-risk environments that focus on substance use issues, personal and family responsibilities, and communication and refusal skills. 'Brief Strategic Family unit Therapy' is an indicated programme designed for families in which children and adolescents exhibit early substance apply, rebelliousness, and/or delinquency. This approach strives to increase and reinforce competent family interactions and behaviours through shifting interpersonal boundaries equally needed, edifice conflict resolution skills, and providing parental coaching25.
Family engagement can range over various modalities, such as telephonic conversations, video sessions, counselling groups, family sessions where the boyish-family interaction is observed as well as dissever sessions with parents, addressing focused upon bug to enhance treatment outcome. Therapy motivations of the parents and family therapy with single parent families are issues that must be clinically assessed and addressed not only before initiating therapeutic contact, simply also during the intervention26. Farther, parents' own substance use difficulties, quality of marital relationship and mental wellness must be assessed and addressed if required to reduce dysfunction in the family and better family atmosphere27. It is advisable to see the family members separately in individual sessions in club to go pertinent information. Some disclosures may be fabricated merely to the therapist and the other family members may be unaware of the disclosed data. Information technology 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 important for the therapist to be objective and not to take sides of any 1 family unit member or a dyad.
Therapist's training and experience is mandatory earlier trying out any intervention. Therapists must be experienced in family therapy skills, and should take had training in individual therapy. Ideally, the therapist must be knowledgeable near family therapy practices as well equally substance corruption treatment practices. Family therapists who wish to care for substance abuse must get themselves informed about bones substance related issues as well as substance abuse treatment processes. This may include screening and assessment of substance use, motivational enhancement techniques, relapse prevention, as well equally training in specific models of therapy, for e.1000. Cognitive Behavioural Therapy for substance abuse or Dialectical Behaviour Therapy for co-morbid substance dependence and emotionally unstable personality. Recently28, it has been recommended that integrated interventions be used for co-occurring substance employ disorders and other psychiatric disorders rather than treating only substance abuse or treating just the co-occurring disorder. This approach will necessitate the availability of experienced clinicians and therapists and training will exist required to equip practitioners in fairly treating the conditions.
Summary and Future Directions
Substance corruption has a tremendous impact on not simply the user simply likewise on the user'due south family. The family can be a hazard factor for substance abuse or it can human activity equally an of import resource for recovery from substance abuse. Marital and family therapy for substance abuse have been found to be efficacious for men, women and adolescents. Family interventions have also been successfully used to foreclose substance misuse. Considering the sheer number of individuals with substance abuse problems in India, effective treatments such as marital and family therapy should be regularly offered to patients and their family members whenever indicated. This would require tremendous and sustained efforts to train a large number of mental wellness professionals in these therapy modalities. Apart from ensuring that quality care is provided, it is also important to make the therapies accessible and affordable. In order to maintain contact with the therapist, feasible and affordable technology driven tools such as mobile messaging and apps, and therapy sessions using the cyberspace can be employed. Defended programmes that involve the family and community are as well required to forestall substance corruption among children and adolescents. These psychosocial interventions are vital for a country like Bharat with its accent on family oriented living.
Fiscal support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of involvement.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844162/
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