Christopher Dare

Evaluation of family treatments in adolescent anorexia nervosa: A pilot study

In the search for more effective methods of psychological treatment in anorexia nervosa, there are a number of controlled trials evaluating the efficacy of different forms of treatment. Previous studies have shown that family therapy is the superior treatment for patients with an early onset and short duration of illness. In order to assess the impact and the effective components of family therapy, we conducted a pilot trial in which consecutive referrals of anorexia nervosa patients were randomly assigned to one of two forms of family treatment: family therapy (conjoint family sessions) or family counselling (separate supportive sessions for the patient and counselling for the parents). Changes taking place within the patient and the family were evaluated at regular intervals, while within and between group comparisons were made. Although tentative, it was found that, in the short term, there were few differences in terms of symptomatic relief between the two treatment groups.

Redefining the psychosomatic family: family process of 26 eating disorder families

This paper reports part of the data from a comparative trial of two forms of family intervention for the management of eating disorders in adolescents. Measures of family process at the beginning of treatment included Expressed Emotion (EE) and the Family Adaptability and Cohesion Evaluation Scales (FACES). EE in the families of both anorexic and bulimic patients were, on the whole, at low levels. The low levels of parental Critical Comments might be taken to represent the conflict avoiding character of the families of psychosomatic patients. However, the families showed low levels of Emotional Overinvolvement, which contradicts the clinical descriptions. The FACES scores revealed patterns that were superficially contradictory to the accepted clinical descriptions in that the patients appeared to have perceived their families as not close and as highly structured. The parents experienced their family structure as more similar to the clinical descriptions, scoring their families as more flexible and cohesive than do the patients. The FACES ideals for family organization scored by patients and parents more nearly equate with the clinical descriptions of enmeshment and lack of boundary structure. The relationship between the research findings and the clinical evaluation will be discussed.

A multi-family group day treatment programme for adolescent eating disorder

We describe a new treatment for the outpatient management of disabling eating disorder in adolescents. The pilot programme has thus far treated 14 adolescents, half with anorexia nervosa and half with bulimia. Most of the young people had been previously admitted or the current referral was for admission. None of the patients has subsequently had to be taken into an inpatient service and the preliminary results suggest that the programme may be beneficial. The programme has elicited a very positive response from the patients and their families. For the professionals involved, the experience of participating in the multi-family group treatment has been unusual and powerful and the training opportunities provided by it seem rather unique. This has led us to make this preliminary communication. We describe the context and structure of the programme and give some details of the patients so far treated. Copyright

The assessment of expressed emotion in a standardised family interview.

This study compared the expressed emotion (EE) scores obtained using individual interviews with parents with the scores obtained in whole family interviews. Interviews were carried out with 31 parents of 16 adolescents referred because of an eating disorder. There was moderate correlation of scores between the two interviews regarding critical comments, emotional overinvolvement, and warmth, but it was low for positive remarks. The study suggests that the whole family interview, which is time saving, is useful in assessing expressed emotion. The levels of expressed emotion, particularly the relatively low levels of critical comments and emotional overinvolvement, are similar to those of previous studies.

A comparative study of family therapy in the treatment of opiate users in a London drug clinic

This study presents the results of a randomized treatment trial of family therapy and two control treatments for 119 outpatient opiate users. All treatments were combined with a methadone reduction programme. The control treatments were: (1) a ‘standard’ treatment (supportive psychotherapy) and (2) a ‘low contact’ intervention. Treatment outcome was evaluated six and twelve months after the initial assessment. Both the family therapy and minimal intervention groups had a significantly higher number of drug–free days at six and twelve months, compared to the standard treatment, despite receiving fewer treatment sessions. Across all treatments there was evidence for a gender difference in response to therapy in users who were in a couple relationship. In couples where both partners were using drugs women did significantly better than men. Men living with a non–drug–abusing partner fared better than men living with a drug–using partner. Across the treatment groups diminution in drug use was accompanied by improvements in psychosocial functioning. Unemployment, sharing needles and injecting drugs were predictive of poor outcome.

Systematic observation and clinical insight--are they compatible? An experiment in recognizing family interactions.

Clinical descriptions of families are often viewed as being too subjective for systematic scientific inquiry. This study examines the extent to which independent observers can recognize statements made about family interactions. These statements were of a type which clinicians dealing with families would make and comprised observations with varying levels of inference. A special method was devised to test a number of specific hypotheses concerning the processes of clinical observation. The results show that such descriptions are recognizable as being made about a particular family even when this involves discriminating between clinically similar families. Some of the implications of these results for observational research are discussed.

Chronic Eating Disorders in Therapy: Clinical Stories Using Family Systems and Psychoanalytic Approaches

This paper presents three pieces of work, all focused around a person presenting with a long history of disordered eating patterns. One treatment was a couple therapy, one a family plus individual therapy and the third a purely individual therapy. The three different psychotherapies demonstrate an approach which uses psychoanalytic as well as family therapy thinking and techniques. The material is offered to show examples of the clinical practice within which individual and couple or family therapy constitute a range of psychotherapeutic responses to people and, in particular, to people with eating disorders. The context of the therapy is described in some detail as it accounts for many features of the treatments, for example, that they are justified within the institution by having been subject to empirical investigation. A metaphor, that of the medieval castle, is offered as an evocation of the experience of the person that is relevant in the practice of both individual and family therapy.

Psychoanalysis and family systems revisited : the old, old story?

This paper explores some commonalities in the current state of psychoanalysis and family therapy in Britain. It argues that there have been social changes within Britain that have increased the popularity of the practices and concepts of psychotherapy and counselling. The methods and ideas of psychoanalysis seem to be the major influence in this process which is manifest, for the most part, within private therapy and counselling and in the universities. It appears that family therapists and the institutes of psychoanalysis act as if unaware of this pragmatic acceptance of psychoanalytic thinking. The two disciplines of family therapy and psychoanalysis remain organizationally and conceptually disassociated from each other despite the two subjects having considerable overlap, plying adjacent trades and using theoretical ideas which show considerable parallels. The paper proposes that postmodern thinking is, potentially, an evolving link between the two forms of thinking and therapy but that the theories of both psychoanalysis and family therapy require empirical evaluation.