Monday, April 27, 2015

Addiction treatment modalities

Outpatient Care

⋄ Techniques vary by clinician but typically include :

  • o cognitive-behavioral therapy
  • o problem-solving groups

⋄ Low success rate with heavily addicted individuals.
⋄ Moderate addicts may find that this level of treatment is enough to end their drug abuse problems.



12 Step Programs

⋄ Clients attend meetings.
⋄ Preferable after or in conjunction with some other form of drug treatment
⋄ There is the belief that they will never "recover" from their drug addiction.
⋄ This type of program may leave many feeling powerless (one of 12 steps is to accept powerlessness) over ever ending their battle with drug addiction.
⋄ This type of program may work for some, but has low success rate.


Inpatient Short-Term Rehabilitation

⋄ Substance abuse treatment that lasts typically for 30 days.
⋄ Overseen by medical professionals and trained counselors, often Certified Drug Addiction Specialist.
⋄ Goals are primarily physical stabilization, abstinence from all use, and lifestyle changes.
⋄ Primarily founded in a modified 12-step approach.


Inpatient Long-Term Rehabilitation

⋄ Inpatient long-term residential program is a 24 hour a day 7 days a week treatment.
⋄ Duration can be from several months to a year or more.
⋄ Residential treatment is conducted in non-clinical settings known as therapeutic communities.
⋄ May also include additional treatment strategies such as social education.


Methadone Maintenance Treatment

⋄ For clients with a dependence on heroin or other morphine like drugs.
⋄ Methadone decreases the feeling of pain and reduces emotional responses to withdrawal symptoms.
⋄ A dose typically suppresses an addict's symptoms for 24 hours.
⋄ Downside:

  • o Clients are physically dependent on
  • o They may find themselves using it for many years after they start treatment.
  • o Methadone may be more difficult to withdrawal from than heroin.
  • o Maintenance involves more time, pain, and expense than heroin withdrawal.





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Monday, April 20, 2015

Adopting Parents


■ The idea of adoption has changed over the last few decades from a last resort to a natural option in creating a family.

■ With the ease of travel many adoptions are from outside the US, blending not only a new family but also cultures and races as well. (known as transracial and transcultural adoption).

■ Adoption occurs for many reasons, such as the wish to expand families or to provide a home for children in need.

  • o Kinship adoption may include grandparents adopting the children of their children.
  • o More single people of both genders are adopting today than ever before, as are gay and lesbian couples.


■ The Decision to Adopt

  • o If the choice is motivated by infertility many issues can accompany the choice.

◆ Feeling of loss
◆ Feeling of giving up on a dream
◆ Anxiety and fear about making this decision
◆ Stress related to how to go about adoption, how society will impact their decision, how their families and support systems will react.

  • o The paper work alone can be overwhelming
  • o Stress may affect a marriage if couples have different coping skills or if one is more ready to adopt than the other.


■ Foster Children

  • o Being able to provide the appropriate medical, emotional, or academic support for foster children with special needs.
  • o Prepared to suffer the potential loss of the relationship if child is returned to home or adopted by another family.
  • o Stress of how to handle the child’s biological parents and family.


■ Parenting Adopted Children
o Address children’s questions about their adoption, about birth parents, and be able to prepare child for questions by others about their adoption.
o Any parent has to be aware of changes in behaviors that indicate an emotional struggle, such as:

  • ◆ Social withdrawal
  • ◆ In attentiveness that affects productivity at home or school
  • ◆ Anger outbursts and temper tantrums
  • ◆ Attachment anxiety, fear of being alone
  • ◆ Changes in eating or sleeping patterns.


■ Role of Family Therapists

  • o Help the family understand the impact of adoption on the family and the child
  • o Work with the children who may have a hard time talking to adoptive parents about the adoption fearing it might show a sign of disloyalty or being unappreciative.
  • o Normalizing the feelings of wanting to learn about their biological parents and the reasons why they were put up for adoption.
  • o Work with the biological children in the family giving them a place to explore their feelings about the adoption.
  • o With the adjustment to new relationships, the family therapist can ensure positive communication and creating appropriate boundaries to benefit the children and strengthen the family.




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Monday, April 13, 2015

Assessments in Family Therapy

Self-report scales




■ Cost effective to administer

■ Provide information on how family members evaluate their own functioning.

The Dyadic Adjustment Scale (DAD)
■ 32-item measure of marital quality and marital adjustment
■ Four subscales measure

  • • marital satisfaction
  • • cohesion
  • • consensus
  • • affective expression


■ The Family Environment Scale (FES) is a 90-item true/false measure assessing how family members perceive their family environment along the three domains of relationships, personal growth and system maintenance.

■ The Family Questionnaire (FQ)
o Brief measure of perceived criticism and overinvolvment.

■ The Family Assessment Device (FAD)
o 60-item scale that assesses the six dimensions of the McMaster Model of Family Functioning

  • ■ Communications
  • ■ problem solving
  • ■ affective responsiveness
  • ■ affective involvement
  • ■ roles
  • ■ behavior control



Interview-based family assessment instruments

■ More labor intensive and require rater training.

■ Provide an outside perspective on how a family functions compared to other families.

■ The Camberwell Family Interview o Requires extensive training
o Used to assess levels of criticism and overinvolvment.

■ The Five Minute Speech Sample o Method of assessing expressed emotion in relatives of patients with psychiatric disorders.

■ The McMaster Clinical Rating Scale (MCRS) o Based on a family interview conducted by a rater
o Assesses the same six dimensions of family functioning as the FAD in addition to assessing the overall health/pathology of a family.
o Inter-rater and test-retest reliability as well as concurrent and discriminative validity.
o Can take from 45 to 90 minutes depending on the experience of the rater.





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Monday, April 6, 2015

Family Therapy for Childhood and Adolescent Disorders

■ Family Risk and Protective Factors
 o Childhood and adolescent behavior problems have been strongly and consistently linked to a number of family factors, such as conflict and aggression.
o Longitudinal studies show that ineffective parenting practices in childhood maintain antisocial behavior into adolescence.



■ Family based interventions for child behavioral problems
 o Various family therapy approaches specifically target the coercive family patterns maintaining behavior problems while at the same time bolstering protective factors in the family and other systems that have an impact on the child.

■ Engagement and Retention Therapy
 o One of family therapy’s major contributions is an increased focus on strategies for engaging difficult youth and their families in treatment

■ Parent Management Training
o Focusing on the parent in treatment
o Helping parents identify, observe, and react to the child’s problem behavior in new ways
o Applying social learning principles to increase parenting skills to shape the child’s behavior.
o Providing opportunities to practice new parenting skills and apply them in the home.

■ Functional Family Therapy
 o This model is based on the assumption that children’s behavior problems serve a function within the family system and are initiated and maintained by maladaptive interpersonal processes.
o Treatment targets change in these destructive interactional patterns and uses behavioral interventions to reinforce positive ways of responding and to establish more effective problem-solving

■ Multisystemic Therapy
 o Several different models have demonstrated efficacy and are generating evidence of effectiveness community-based replication studies.
o These therapies promote positive outcomes such as more pro-social peer relationships and family functioning, as well as reducing conduct problems.






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Monday, March 30, 2015

Child Custody

Therapy Contract
o Foundation based on court order.
o Frequency must be determined prior to counseling process; many will only participate for court minimum requirements.
o Specific confidentiality contract and explanation of confidentiality limitations in essential.



Alliance Building
o Any alliance can be experienced as an alliance against the other in these families
o Extra effort is necessary to establish a multipartial alliance in which the therapist is experienced as caring but also fair.
o Counselor must be honest, provide direct feedback about the behavior occurring but reframe changes sought in the most positive light.
o Problematic behaviors related to the conflict are directly confronted, but the positive intent of each client is always underscored.

Assessment
o Begin with a form of evaluation that involves:

  • ⋅ Separate meetings with each parent (with or without new spouses, depending on the issues involved) and children
  • ⋅ A review of records of filings in court and other relevant reports available
  • ⋅ Consultations with other therapists involved.

o Identify family strengths and weaknesses.

Treatment Plan
o Should include not only the traditional goals but also:

  • ⋅ Format of future sessions of who will participate
  • ⋅ In what combinations, at what time, and focused on what issues.

o Goal Setting
⋅ Main goal is to reduce the damaging aspects of custody disputes:

  • high conflict
  • triangulation
  • broken family structure
  • lack of safety
  • Impact on daily functioning





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