“I’m still here, but no one hears you”: a qualitative study of young women’s experiences of persistent distress post family-based treatment for adolescent anorexia nervosa

Background Family-based treatment (FBT) is the current treatment of choice for adolescent AN based on positive outcomes that include weight restoration in around two-thirds of adolescents. Nevertheless around a quarter drop-out from treatment, particularly in the earlier phases, and a notable proportion of treated adolescents are reported to experience ongoing psychological distress during and post-treatment. This study explores the under-researched experiences of these adolescents. Method Fourteen participants from Australia, New Zealand and the United Kingdom were interviewed about their experiences of FBT. An inductive thematic analysis of interview transcript data generated key themes related to their experiences, identity negotiations and the discursive materials these used to construct these. Results The participants identified working as a family unit as key to their recovery, highlighting the importance of family therapy interventions for adolescent AN. However, they perceived an almost exclusive focus on weight restoration in the first phase of FBT was associated with experiences that included a relative neglect of their psychological distress and a loss of voice. Key within these experiences were processes whereby the adolescent engaged in identity negotiation and (re)claiming of their voice and implicit in their family standing with them in the treatment was that their life was worth saving. What was noted as most helpful was when therapists advocated and took into consideration their unique needs and preferences and tailored treatment interventions to these. Conclusions There is a need to develop and research treatments that address, from the outset of treatment, the adolescents’ psychological distress (including as experienced in the context of their weight restoration). This should be with priority accorded to the adolescent’s voice and identity negotiations, as they and their families take steps to address the physical crisis of AN and in doing so, support more holistic and durable recovery.

Integrating Buddhist-Informed Interventions Into Narrative Family Therapy

Culturally responsive couples and family therapy requires incorporating spirituality into clinical practice at the clients’ request. Researchers led a focus group with Buddhist practitioners who work in clinical care settings to better understand the degree of fit between Buddhist practices and narrative family therapy interventions. Compatible practices included mindfulness, externalization, and self of therapist work. While narrative family therapy's model of change has points of divergence from Buddhism, there are ways to incorporate Buddhist beliefs into narrative practices.

"I’m Still Here, But No One Hears You": A Qualitative Study of Young Women’s Experiences of Persistent Distress Post Maudsley and Family-Based Therapy for Adolescent Anorexia Nervosa

Background: Maudsley and Family-Based Therapies (MFT/FBT) are the current treatment of choice for adolescent AN based on positive outcomes that include weight restoration in around two-thirds of adolescents. Nevertheless around a quarter drop-out from treatment, particularly in the earlier phases, and a notable proportion of treated adolescents are reported to experience ongoing psychological distress during and post-treatment. This study explores the under-researched experiences of these adolescents. Method: Fourteen participants from Australia, New Zealand and the United Kingdom were interviewed about their experiences of MFT/FBT. An inductive thematic analysis of interview transcript data generated key themes related to their experiences, identity negotiations and the discursive materials these used to construct these. Results: The participants identified working as a family unit as key to their recovery, highlighting the importance of family therapy interventions for adolescent AN. However, they perceived an almost exclusive focus on weight restoration in the first phase of MFT/FBT was associated with experiences that included a relative neglect of their psychological distress and a loss of voice. Key within these experiences were processes whereby the adolescent engaged in identity negotiation and (re)claiming of their voice and implicit in their family standing with them in the treatment was that their life was worth saving. What was noted as most helpful was when therapists advocated and took into consideration their unique needs and preferences and tailored treatment interventions to these. Conclusions: There is a need to develop and research treatments that address, from the outset of treatment, the adolescents’ psychological distress (including as experienced in the context of their weight restoration). This should be with priority accorded to the adolescent’s voice and identity negotiations, as they and their families take steps to address the physical crisis of AN and in doing so, support more holistic and durable recovery.

Psychotherapy Practice and Research

This chapter reviews researches on the processes and outcomes of psychotherapy. The research indicates use of varied modalities including cognitive behavioural therapies, psychodynamic approaches, and couple and family therapy interventions. These techniques are used in varied contexts such as medical and surgical consultation-liaison settings. Models of care and service delivery have been translated to facilitate the shift from the clinic to the community, accompanied by an expanded role for counsellors and therapists. Cultural sensitivity in the practice of therapy and in the shift to culturally relevant models of therapy and practices like yoga and meditation is evident. Experiential, qualitative studies tapping psychotherapy processes and the inward gaze towards psychotherapist training, development, and professional issues collectively chart a path less trodden. The practical impediments to progress in psychotherapy practice, training, and research in the country are discussed and pathways for future are outlined.

Evaluating the effectiveness of a culturally adapted behavioral family psycho-educational program for Egyptian patients with schizophrenia

Although a growing body of evidence supports the effectiveness of behavioral family therapies for patients with schizophrenia, few studies have been carried out on the effectiveness of such programs for Egyptian patients. The current study translated and culturally adapted the Behavioral Family Psycho-Education Program (BFPEP) and conducted a preliminary efficacy evaluation for outpatients suffering from schizophrenia. Thirty patients received 14 sessions of culturally adapted Program (CA-BFPEP) and 30 received treatment as usual; all were followed up for 6 months. Pre- and post-intervention assessment included primary outcome measures that assessed the clinical, social, quality of life and attitude towards medications. The CA-BFPEP group demonstrated significant treatment effects as they had greater reductions in psychotic symptoms (PANSS), improvement of social function (SFQ), quality of life (QoL), and attitude towards medications (DAI), compared to patients in the control group. These results demonstrate the feasibility of implementing family therapy interventions in different cultural settings with relatively minor modifications. These promising findings invite further efforts to maximize the benefits of family therapy interventions internationally and to encourage mental health policy makers to integrate this mode of therapy in routine care management plans for patients with schizophrenia.