Gilbert Lemmens

The effects on mood of adjunctive single-family and multi-family group therapy in the treatment of hospitalized patients with major depression. A 15-month follow-up study.

Background: Family-based interventions have been shown to be effective in the treatment of depression, but they have seldom been studied in hospitalized depressed patients. This study assesses the value of the additional use of single-family or multi-family group therapy within this patient population. Methods: Eighty-three patients were randomly assigned to: (1) the treatment programme as usual (n = 23), (2) treatment as usual combined with single-family therapy (n = 25) or (3) treatment as usual combined with multi-family group therapy (n = 35). Follow-up assessments were made at 3 months and 15 months. Results: Multi-family group and single-family therapy conditions showed significantly higher rates of treatment responders than the group receiving the usual treatment (49, 24 and 9%, respectively), and higher rates of patients no longer using antidepressant medication (26, 16 and 0%, respectively) at 15 months. Partners taking part in the family treatments were significantly more likely to notice the improvements in the emotional health of the patient early on compared to those in the treatment as usual condition. Conclusions: This study suggests that single-family and multi-family therapy may benefit hospitalized patients with major depression, and may help the partners of the patients to become aware of the patient’s improvement more quickly.

Beneficial factors in family discussion groups of a psychiatric day clinic: perceptions by the therapeutic team and the families of the therapeutic process

This paper reports a pilot investigation of the perception of helpful events by the therapeutic team and the families in two family discussion groups (FDGs) of a psychiatric day clinic. All participants of the FDG, including therapists and observers, filled in questionnaires measuring events helpful for the individual, for the family and for the group after each FDG session. The results showed that the therapeutic team and the families diverged in their overall perception of which factors were important in family discussion group therapy. The therapeutic team saw the relational climate and the structural aspects of the group (including group involvement and support from the group), and specific therapeutic interventions as more helpful than the families. The process aspects in the group members (including the experiencing of communality and gaining insight) were, on the other hand, more frequently mentioned by the families than by the therapeutic team. The clinical implications of these findings and suggestions for future research are discussed.

Marital satisfaction, conflict communication, attachment style and psychological distress in couples with a hospitalized depressed patient

Background: There has been fairly consistent empirical support for the association between major depressive disorder and marital dissatisfaction. However, this evidence is limited mostly to out-patient and population-based samples. Further, the role of possible mediating factors such as attachment style and conflict communication are less well investigated in major depression. Objective: The present study aims to investigate whether couples with a depressed partner and nonclinical couples differ in marital satisfaction, attachment style, psychological distress and conflict communication. Gender differences are also investigated. Methods: Seventy-seven couples, who participated in a family intervention trial, were compared with 77 age- and gender-matched nonclinical couples. Results: The depressed patients reported more psychological distress and attachment difficulties and less marital satisfaction than their partners and the nonclinical couples. Partners perceived their relationship as more satisfying than the nonclinical couples. The clinical couples reported less mutual constructive and more mutual avoidant communication in their relationship compared with the nonclinical couples. Finally, female depressed patients reported higher levels of psychological symptoms and were more avoidant attached than male patients. Conclusions: This study shows important differences in several individual and relational characteristics between couples with a depressed partner and nonclinical couples. Further research will be necessary to clarify whether the investigated psychosocial variables play a causal and/or a maintaining role in depression.

Chronische pijn en de familie

Van chronische pijn is er sprake wanneer de pijn langer aanwezig is dan zes maanden en niet reageert op de traditionele medische en chirurgische behandelingsmethoden. Per definitie geven uitgebreide onderzoeken, adviezen van verschillende artsen en frequente ziekenhuisopnames niet altijd een eenduidig antwoord op het lijden van de patient (Rowbotham, 1995). Een werkzame behandeling blijft dan ook vaak uit of betekent slechts een gedeeltelijke oplossing. De pijngeschiedenis gaat onvermijdelijk hand in hand met veranderingen in het sociale en familiale leven. Verschillende patienten verliezen immers hun werk. Financiele problemen binnen het gezin kunnen ontstaan doordat het inkomen afneemt en uitgaven door medische kosten toenemen. Pijn en invaliditeit gooien bovendien de rollen en verantwoordelijkheden binnen het gezin door elkaar: vader neemt de rol van “huisvrouw” op zich, de dochter verzorgt haar altijd zo sterke moeder en verliest hierdoor gedeeltelijk haar status van kind-zijn.