Plena - SP01-05 - SP06-10 - SP11-15 - SY01-06,14 - SY07-13 - SM01-06 - SM07-13 - SM14-20 - SM21-27 - SN01-05 - SN06-10 - SN11-15 - SN16-21 - SN22-26 - SN27-32 - SN33-37 - SN38-43 - P01-13 - P14-28
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SN01: Contextual and Conceptual Approaches to Therapy with Adolescents (Kontextuelle und konzeptuelle Ansätze der Therapie mit Jugendlichen) - English
Russell Crane, Harvey Hillin, Scott F. Jakubowski (USA):
Costs of Treating Conduct Disordered Youth with and without Family Therapy (Therapiekosten bei verhaltensgestören Jugendlichen mit und ohne Familientherapie)
One of the objections to including family therapy in healthcare systems has been the fear of generating increased costs to the system. This study investigated the healthcare costs of youth treated for conduct disorder in the State of Kansas Medicaid system. In a naturalistic, retrospective design, youth who received treatment for conduct disorder were followed for a period of 30 months. Overall, 3086 youth received care that included individual therapy (and no family therapy), 503 received in-home family therapy and 164 others received in-office family therapy.
Results: The average cost of healthcare for youth receiving no family therapy was $16, 260. For those receiving in-office family therapy, the average cost was $11,116. Youth who received in-office family therapy received $5,144 (32%) less care on average than those receiving only individual therapy. Those who received in-home family therapy averaged $1,622 over the follow-up the period. Those who received in-home family therapy were least expensive of all, averaging at least 85% less than any form of in-office therapy. Although there are undoubtedly large group differences between the youth, two conclusions seem warranted: 1. Family therapy is not a common component of treatment for conduct disorder. 2. There does not appear to be an increase in the healthcare cost when family therapy is included in treatment.
Catherine Ducommun-Nagy (CH/USA):
If You Learn to Tame them, You won‘t Need to Cage them. Contextual Therapy for Adolescents with Severe Conduct Disorders (Wenn Du sie zähmen lernst, brauchst Du sie nicht einsperren. Kontextuelle Therapie für Jugendliche mit schweren Verhaltensstörungen)
Adolescents with severe conduct disorders have raised many challenges for society and for the therapists who have tried to reach them. Unable to win them over, therapists are at risk of engaging in an escalation of coercive measures including their institutionalization in increasingly restrictive settings up to the point of actual incarceration. Contextual therapy proposes an alternative path to a mutual escalation of violence: These adolescents need to be addresses as depleted givers rather than heartless takers. Adolescents who have developed antisocial behaviors are often parentified children’s whose generous giving was exploited rather than recognized. They need to be help to rediscover the courage to give that will allow them to find a new self-esteem based on actual contribution to society rather than a false sense of strength stemming from the knowledge that they can terrorize anyone around them. This approach has been applied successfully to a cohort of homeless young adults who had an extensive history of violence as teens and will be demonstrated to the participants. Seriously antisocial youths can respond to interventions based on the mobilization of their residual capacity to give that lead to more improvement of their behaviors than most behavioral interventions.
A. Papadopoulou, A. , K. Gini, Ch. Sidiropoulos, E. Kouneli, Th. Papadakis (GR):
A Multifactorial Approach in the Therapy of Children and Adolescents (Ein multifaktorieller Ansatz in der Therapie von Kindern und Jugendlichen)
The paper describes a specific therapeutic scheme for children or adolescents, which includes participation in group therapy, both: of the identified patient and the parental couple. According to the age of the identified patients, group therapy consists of participation in a sociodynamic multiple activity group for young children, a psychodrama group for pre-adolescents and a psychodrama group or group analytic group for adolescents. Parents group consists of the parental couple's participation in a small psychoeducational type of group (3-4 couples), which is coordinated with a group analytic orientiaton by a couple of therapists, on a monthly basis. It has been observed that the above therapeutic scheme helps to utilize the healthy potential of the family system, to the advantage of both, the «patient» and the other family members. Particularly this therapeutic approach appears: 1) to unify the family's structure when it splits between the roles of the healthy members (parents, siblings) and the unhealthy (identified patient), 2) to mobilise the therapeutic potential in the family structure, which in return favours the persistence of the patient in his/her therapy, and 3) to enhance the benefits of the development and evolution both of the family structure as a whole and of each family member separately, especially of the identifie patient.
SN02: Systemische Sozialarbeit (Systemic Social Work) - Deutsch
Fachgruppe Soziale Arbeit in der DGSF:
Michaela Herchenhan, Sabine Heppel (D):
CLEARTALK© in öffentlichen Jugendhilfeinstitutionen (CLEARTALK© in the Context of Public Youth Service Institutions)
CLEARTALK© bildet als systemisches Konzept die Grundlage für Unterstützung von Familien. Wir stellen das Konzept von CLEARTALK© sowie den konkreten Ablauf vor und berichten über einige evaluierte Daten aus der Praxis in einem deutschen Jugendamt.
Ludger Kühling (D):
Wie können Einrichtungen der Kinder- und Jugendhilfe systemisch werden? (How can Child and Youth Service Institutions become Systemic?)
Drei erprobte Varianten einrichtungsinterner Lernprozesse werden vorgestellt, wobei jeweils die Besonderheiten der unterschiedlichen Varianten und ihre Passung für die Einrichtung im Mittelpunkt stehen.
Renate Zwicker-Pelzer (D):
Aktivierung des sozialen Netzes als systemische Intervention in Sozialer Arbeit (Activating Social Networks as Systemic Intervention in Social Work)
Familientherapeutische Praxis und Forschung liefern viele neue Ideen zur wirksamen Nutzung von Netzwerkarbeit. Ihre Relevanz für die Erzielung nachhaltiger Prozesse in der professionellen Sozialen Arbeit wird dargestellt und reflektiert.
SN03: Preventive Interventions for Troubled Families (Präventive Angebote für belastete Familien) - English
Marianne Sipilä, Tytti Solantaus, Marit Alasuutari, Sini Toikka (FIN):
Prevention of Children´s Disorders in Families with Mentally III Parents: The Beardslee Preventive Family Intervention (Prävention von Verhaltensstörungen bei Kindern von psychisch kranken Eltern: Die Beardslee-Präventivintervention für Familien)
Parental mental illness increases children's risk for developmental problems and mental disturbances. According to several studies, about 60% of children of affectively ill parents will themselves suffer from psychiatric disorders by the age of 25. These children urgently need preventive measures. The Beardslee Preventive Family Intervention was developed by the Beardslee team in Boston, USA, to support the families and the children of mentally ill patients. The aim is to prevent children's disorders. The Intervention focuses on enhancing supportive processes in the family - joint parenting, understanding of parental illness, the child's activities outside the home. A family narrative is created in sessions with the parents and with the children. In the planning session with the parents, they decide what they want to tell their children about the mental problems, the family situation and how they want to answer their children's questions. Psychoeducational material is imbedded in the family's own experiences. The presentation will focus on the principles and practices of the Beardslee Intervention.
Tytti Solantaus, Maarit Alasuutari, Sini Toikka (FIN):
Finnish Families' Experiences of the Beardslee Preventive Family Intervention: Preliminary Results of Safety and Feasibility in a Randomized Controlled Study (Erfahrungen finnischer Familien mit der Beardslee-Präventivintervention für Familien. Vorläufige Ergebnisse über Sicherheit und Durchführbarkeit in einer randomisierten Kontrollstudie)
The Study Question The Beardslee Preventive Intervention is designed to prevent children's disorders in families with mentally ill parents. The Intervention is being studied and compared with a short parent intervention (Let's Talk About Children) in a randomized controlled setting in Finland. The aim of the study is to find out the effectiveness of the interventions, as well as to learn which families need the longer, which ones can do with the shorter intervention. Material and methods Psychiatric patients attending mental health clinics form the basic population for the study. Patients with mood disorder as the first diagnosis and with children between 8-16 are randomized into one or the other study group. There will be 180 families with about 250 children in the study. The parents and children will be studied by means of questionnaires, a subsample will be interviewed. Preliminary results of safety and feasibility among the first 50 families will be reported.
Mika Niemelä, Leena Väisänen (FIN):
The Preventive Family Intervention Project in Northern Finland Depressed Parents and Their Children (Das präventive Familien-Interventionsprojekt in Nordfinnland für depressive Eltern und ihre Kinder)
The Beardslee Preventive Intervention is being applied in Northern Finland. The project was launched in 2002 in the province of Oulu, and in spring 2004 staff from nearly all municipalities in the region are participating in the training. The training curriculum includes introductory lectures, practical exercises and supervision. Because most of the parents suffering from depression are recognised and treated in primary health care, general practitioners and interprofessional primary service teams have been recruited in particular to take part in the training. This project has increased cooperation between primary services and specialised care. New alternative applications of the Intervention are also being developed. The Oulu University Hospital cancer clinic has taken up the working model, and families with mothers suffering from breast cancer are offered the Intervention. The aim of this presentation is to describe the implementation and the applications of the Preventive Intervention in primary health care, social work and in families with mother suffering from breast cancer.
SN04: Gender Narratives (Geschlechtsspezifische Narrative) - English
Regina Batista, Vera Celestino, Renata Dias, Ana Marques,
Margarida Oneto, Joana Rodrigues (P):
The Feminine Identity in a Modern Society - a Case Study Based on the Coordinated Management of Meanings Model (Weibliche Identität in einer modernen Gesellschaft - eine auf dem Coordinated Management of Meanings Modell beruhende Fallstudie
One of the intervention models of the Centre of Family and Individual Therapy is the Coordinated Management of Meanings (Pearce & Cronen, 1989, 1994). Although not often referred to in family therapy literature, this model has a quite long history in the communications study domain. The model distinguishes five levels of context: speech acts, episodes, relationships, identity and culture.
The realm of the presented case being in fact transversal to all levels, we consider the culture and identity levels as the most significant in this case.
At the level of the speech acts, the patient shows a sad and negative discourse, built up alongside a series of experiences of violence and abuse (episodes). Such experiences emerged in a cultural context where women had no freedom or autonomy to voice their painful episodes. This same culture would also have a hold over lifetime relationships, at family as well as professional level, in which the status of women was deemed to be lower (relationships). This woman’s identity is expressed through sadness, frustration, concomitant feelings of outrage and helplessness concerning the lived past.
We intervened at the level of the speech acts, using the Appreciative Inquiry (Cooperrider, 1999) so as to obtain a change in the client’s language and to allow a reconstruction of her identity, enhancing a more optimistic view of time to come and her better integration in a modern society.
Jasminka Veselinovic (YU):
Gender Narratives in the Therapeutic Process (Geschlechternarrative im therapeutischen Prozess)
Every culture, just as each family, forms specific constructions of differences between genders and which aims at defining possible male and female stories and possible relationships between them.
I would like to present how gendered internalized working models of self and others, create and maintain difficulties which is exspressed through female and male narratives in couple therapy. I will use some original material from male and female narratives for illustration.
I started from the idea that not only the roles and patterns of relationships are generalized, but also the very language and female and male narratives. Gender narratives is not perceived as a static given quality, but as a quality which has interactive, reflexive and changeable dimension in therapeutic process.Taking in consideration that gender is a basic organizer of personal life and that it is formed and expressed and by language, it is inevitable to develop gender sensitive therapy without developing therapeutic sensitivity for gendered narratives and working with them.
Violeta Kaftantzi, M. Karakitsou, T. Zotou, S. Chatzi, V. Sarafianou,
G. Gadona:
Women´s Stories. A Systemic Investigation on Problems of Women Asking for Psychological Help (Geschichten von Frauen. Eine systemische Untersuchung von Problemen von Frauen, die psychologische Hilfe in Anspruch nehmen)
Within a systemic framework, the possible relation between women’s psychological problems and various factors of their family life and history is investigated. The sample comes from the archives of the M. H. C. of West Thessaloniki. It is consisted of 229 women who asked for help during the years 1997 - 1999. Demographic data (age, education, marital status etc) and basic variables of family life (family‘s life cycle, relations, stressful events etc) are investigated in relation with their present problems (relationship problems, psychiatric problems etc. ). The statistical analysis of the data indicated a predominance of some variables such as the high level of education, the marital status, the occupation, the cycle of family life in adolescence and in young adulthood etc. It also indicated a predominance of relationship problems in the first of these family’s life phases and a predominance of psychiatric problems in the second. The results of the ongoing data analysis so far highlight the importance of various personal and family variables that seem to be critically connected with the present psychological problems of the Greek women.
SN05: Drogen und Familie (Drug Abuse and the Family) - Deutsch
Andreas Schindler R. Thomasius, P. M. Sack, B. Gemeinhardt, U. Küstner (D):
Effektivität einer familientherapeutischen Frühintervention bei drogenabhängigen Jugendlichen und jungen Erwachsenen (Drug Dependence in Adolescence: Outcome of Family Therapy as an Early Intervention)
Problemstellung: Kontrollierte Evaluation einer ambulanten, kurzen, systemischen, medikationsfreien familientherapeutischen Frühintervention bei drogenabhängigen Jugendlichen und Jungerwachsenen.
Methode: Die Evaluation basiert auf intent-to-treat Daten: komparativ, prospektiv, naturalistisch, pre–post. Stichprobe: N=86 Familien (86 Patienten, 76 Mütter, 57 Väter, 36 Geschwister) und eine Kontrollgruppe von N=38 stationären Patienten einer therapeutischen Gemeinschaft. Evaluationskriterien: Suchtstatus, Familiendynamik, Symptombelastung, psychosoziale Integration und Therapiezufriedenheit.
Ergebnisse: Die Abbrecherquote lag in der Familientherapie bei 28%, in der Kontrollgruppe bei 63%. Von den Nicht-Abbrechern der Familientherapie verbesserten sich 63% in ihrem Suchtstatus. Sowohl die Drogenabhängigen als auch die Mütter verbesserten sich in den anderen Zielkriterien. Die Nicht-Abbrecher der Kontrollgruppe verbesserten sich am deutlichsten.
Schlussfolgerung: Ambulante Familientherapie ist eine effektive Behandlung für Jugendliche und Jungerwachsene, die sich in einem Frühstadium der Abhängigkeit befinden und noch Kontakt zu ihren Herkunftsfamilien haben.
Agnes-Christine Nelle, A. Trambow (D):
„Wie kann ich Dir jemals wieder trauen?“ - Systemisch-lösungsorientierte Behandlung von Suchtproblemen mit Paaren
Problem: Die Alkoholabhängigkeit einer/s Partnerin/des Partners verursacht häufig schwerwiegende Probleme in der Paarbeziehung, die in den meisten Fällen auch dann noch fortbestehen, wenn der suchterkrankte Partner mit dem Trinken aufgehört hat und mit einer Therapie begonnen hat. Den Partnern/innen suchtkranker Menschen fällt es in der Regel sehr schwer, wieder Vertrauen zu fassen, da sie in der Vergangenheit immer wieder enttäuscht wurden. Indem sie ihr altes Muster von Kontrolle und Mißtrauen weiterhin aufrecht erhalten, begünstigen sie häufig das, was sie am meisten fürchten: den Rückfall.
Resultate: Der Workshop verdeutlicht die Bedeutung und den Nutzen systemisch-lösungsfokussierter Suchttherapie für solche Paare. Er präsentiert nützliche Interventionen, Fallbeispiele, Videomaterial und Evaluationsergebnisse. Er basiert auf den Erfahrungen des seit vier Jahren bestehenden Modellprojektes NIK-Ambulanz in Bremen.
Schlußfolgerungen: Die Suchttherapie muß Wege finden, die PartnerInnen der KlientInnen einzubeziehen, um den oben beschriebenen Teufelskreis zu unterbrechen und den betroffenen Paaren zu helfen, ihre Beziehung zu verbesseren und das Suchtproblem zu lösen.
"How Can I ever Trust You Again?" - Systemic Solution Focused Addiction Treatment with Couples
Problem: One partners’ alcohol addiction usually causes severe problems in a couples relationship, which tend to continue even after the problem drinker has stopped drinking and started therapy. Their partners find it extremely difficult to dare to trust them again for they have been disappointed many times in the past. By continuing their old pattern of mistrust and control the problem drinkers’ partners often make more likely what they fear the most: relapse.
Results: The presentation shows the importance and usefulness of systemic solution focused addiction treatment for such couples. It presents useful interventions, case examples, video tapes and evaluation results. It is based on four years of experiences from the German model project “NIK-Ambulanz” in Bremen.
Conclusions: Addiction treatment has to find ways to get the clients’ partner involved in order to stop the vicious circle described above and help the couple to improve their relationship and solve the addiction problem.
Ruthard Stachowske (D):
Wirksamkeit multigenerationaler Familientherapie bei Drogenabhängigkeit
Die Fragestellung ist der Zusammenhang zwischen der Manifestation von Drogenabhängigkeit und dem System der Generationen. Mit ca. 80 Familien sind mehrgenerationale familientherapeutische Sitzungen durchgeführt worden, ein Teil dieser Familiengeschichten ist in einer besonderen Weise analysiert worden. Methoden: Mehrgenerationen Familientherapiesitzungen, Genogrammarbeit, Rekonstruktionen, Forschung von familien- und zeitgeschichtlichen Ereignissen.
Ergebnisse: So sind individuelle Lebensverläufe durch generationsübergreifende Prozesse beeinflusst, in allen Familiengeschichten sind „versteckte Abhängigkeitserkrankungen“ deutlich geworden, Täter- und Opferfamilien aus den Kriegen des letzten Jahrhunderts und aus den europäischen Diktatoren haben geheiratet. Die Kinder und Enkel dieser Familiensysteme waren die drogenabhängigen Klienten, die wir kennen gelernt haben, die verdrängte 200 Jahre alte Geschichte der aktuellen Drogensubstanzen im europäischen Kulturraum ist erforscht worden.
Die Perspektive einer mehrgenerationalen Entwicklung von Drogenabhängigkeiten sowie Theorie und Behandlungskonzepte, sollten in Theorie und Therapie von Drogenabhängigkeit eingeführt werden. Neue Modelle der Prävention sind denkbar, wenn das weitere Familiensystem und die Generation schon früh an Therapien beteiligt werden.
The Effect of a Multigenerational Family System on Drug Addiction
Does a family system have an influence on the manifestation of drug-addiction and drug abuse on nowadayas generations? 80 family-therapy sessions have been carried out in which parts of the particular family history was analysed with the use of genograms and the reconstruction of important family-relevant an historical events. Results: individual life progressions are influenced by intergenerational processes. In every family history "hidden addiction diseases" could be found. Many of the drug-addicted clients that we work with are children or grandchildren of families that where either offenders or victims in the world wars of the last century. The forgotten 200 year old history of addictive substances in the european area has been described. Conclusions: The perspective of a multigenerational development of drug-addiction should be introduced in the common treatment of drug-addiction. Prevention of drug-addiction could be enhanced by the participation of the family-system in an early stage of drug-therapy.