Family therapy ‘lite’?

Dr. Andreas Vossler

Dr. Naomi Moller

Systemic

family

counselling

in a primary care context

Talk outline

• Rationale for talk

• Study 1 – What is (Relate) ‘family counselling’?

• Study 2 – Who presents for family counselling at Relate?

• Tentative conclusions

https://web.relate-londonse.org/

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• 20% of children and adolescents experience depression, anxiety, behaviour problems or hyperactivity (CAMHS Outcomes Research Consortium, 2004)

• 1 in 10 children and young people aged 5 - 16 suffer from a diagnosable mental health disorder Green, H., McGinnity, A., Meltzer, H., et al. (2005). Mental health of children and young people in Great Britain 2004. London: Palgrave.

Family Therapy in primary care

• Significant evidence of efficacy of family therapy Carr, A. (2014a). The evidence base for family therapy and systemic interventions for child-focused problems. Journal of Family Therapy, 36, 107-157.

Carr, A. (2014b). The evidence base for couple therapy, family therapy and systemic interventions for adult-focused problems. Journal of Family Therapy, 36, 158-194.

• …Yet lack of family services in primary care mental health Barnes, D., Hall, J. & Evans, R. (2008). Survey of the Current Provision of Psycho- logical Therapy Services in Primary Care in the UK. Chichester: Artemis Trust

• Value of primary care setting for family work: • Non-stigmatising • Local • Team familiar to family • Professional team with potentially long-standing/broad knowledge of family

Shepherd, M. (2014), Do primary care psychological therapists ‘think family’? Challenges and opportunities for couple and family therapy in the context of ‘Improving Access to Psychological Therapies’ (IAPT) services. Journal of Family Therapy, 36: 39–61.

Opportunities?

• Shifts in provision of primary care mental health services e.g.:

• IAPT – service aim to offer broader service, promotion of couple therapy for depression

• Any Qualified Provider initiative - opens door to individuals/3rd sector organisations

• Creates potential opportunities to offer family/systemic therapies in primary care

Why ‘family counselling’?

• Family Therapy services traditionally Tier 2 + 3

• Gap in provision at primary care

• Primary care mental health services focus on being: • effective

• brief

• low-cost

• preventative

• low-intensity (compared to tier 2/3)

Defining ‘family counselling’

• Significant evidence of efficacy of family therapy Carr, A. (2014a). The evidence base for family therapy and systemic interventions for child-focused problems. Journal of Family Therapy, 36, 107-157.

Carr, A. (2014b). The evidence base for couple therapy, family therapy and systemic interventions for adult-focused problems. Journal of Family Therapy, 36, 158-194.

• …Yet lack of family services in primary care mental health Barnes, D., Hall, J. & Evans, R. (2008). Survey of the Current Provision of Psycho- logical Therapy Services in Primary Care in the UK. Chichester: Artemis Trust

Shepherd, M. (2014), Do primary care psychological therapists ‘think family’? Challenges and opportunities for couple and family therapy in the context of ‘Improving Access to Psychological Therapies’ (IAPT) services. Journal of Family Therapy, 36: 39–61.

• Value of primary care setting for family work: • Non-stigmatising • Local • Team familiar to family • Professional team with potentially long-standing/broad knowledge of family

Study 1: What is (Relate) ‘family counselling’?

Relate Family Counselling

“Relate family counselling aims to support family functioning and relationships and prevent the negative impact of family crises and breakdown on the wellbeing of children and adolescents”

Study 2: Who presents for family counselling at Relate?

How distressed are families seeking help at Relate family counselling?

Design

• Relate Centre in England offering FC

• Self-report questionnaires at/before first FC session

• Incentive per family and for questionnaire completion (£10 gift token)

Sample

54 families with adult respondents (6 both parents)

• 46 of 60 adult respondents = mother

• age range 17 to 63, mean = 31 years

• ethnicity: 20 reported themselves as ‘white British’ or ‘white English’; 14 as British

or English, 2 as Black African, 1 as British Pakistani; 1 as Brazilian

• 43 adult respondents children 4 to 16 (17 had children outside that range)

• Number of children in family: 1 child: 12; 2 children: 20; 3 children: 14; 4 children:

4; 5 children: 1; 6 children: 1

15 Children respondents between 11-14 (11 no data from parents)

• Sex - 9 boys and 6 girls;

• Ages -11: 3, age 12: 10, age 13: 3, age 14: 2

Instruments

• ‘Systemic Clinical Outcome and Routine Evaluation’ Scale (SCORE-15;

Stratton et al., 2010)

• ‘Family Adaptability and Cohesion Evaluation Scale III’ (FACES-III; Olson,

1986)

• ‘Strengths and Difficulties Questionnaire’ (SDQ, Goodman, 2001).

Results – Presented Problems

- Variety of difficulties, from conduct/behavioural problems to parenting problems and family conflicts, often interrelated.

- Problem descriptions often locate the difficulties in the child/children, (ex-) partner, sometimes external agents (social services, legal systems).

- Lack of a more systemic view of the family problems in client statements

‘Fights within the family’

’‘Violent ex-partner / extended family issues’

‘We argue a lot and don’t talk to each other’

‘Problems at school that escalate into home life’

‘School have picked up on self harming, generally angry‘

‘Daughter’s behaviour, split of parents, lying, communication’

‘Argument, tantrums, bad feelings, money problems, intimacy problems’

‘Me and my brother argue a lot, I get bullied at school’

Results – Child Distress How distressed are the families in terms of child functioning?

SDQ-Scales Normal Borderline Abnormal MK Parents MK Children

Emotional Problems 0-3 4 5-10 5.5 [0-10]

5.2 [3-7]

Conduct Problems 0-2 3 4-10 4.7 [0-10]

4.8 [3-7]

Hyperactivity - 0-5 6 7-10 6.4 [1-10]

6.9 [4-10]

Peer Problems 0-2 3 4-10 3.7 [0-8]

2.7 [0-5]

Prosocial 6-10 5 0-4 7.1 [2-10]

6.1 [4-7]

Impact of problems 0 1 2-10 3.6 [0-8]

3.7 [2-6]

Total score SDQ 0-13 14-16 17-40 20.3 [9-30]

19.6 [13-22]

Results – Family Distress How distressed are the families in terms of family functioning?

SCORE

Parents (n=59) Children (n=11)

range mean range mean

Strengths and adaptability

108

5 - 22 13.4 5-21 12.4

Overwhelmed by difficulties 5 - 23 15.1 8 - 21 12.4

Disrupted communication 5 - 23 13.4 8 - 19 13.7

SCORE Total Score 15-61 41.9 30 - 57 38.6

FACES-III Sub-scale

Parents Children

range mean range mean

Adaptability 14 - 38 25.6 14 - 30 25.2

Cohesion 13 - 46 33.1 19 - 46 32.0

Conclusion: How distressed are families seeking Relate FC?

• SDQ/Child distress: Families presenting at MK Relate report similar levels of distress as families in NHS CAMHS settings (SDQ norms)

• FACES: Parents and children see their families as more separated than connected (compared to non-clinical families)

• SCORE: Mean scores around scale mid-point suggest moderate distress – comparable to individuals in systemic family therapy (Stratton et al., 2014).

Family Therapy ‘lite’ in a primary care context: Tentative Conclusions and Implications

• Systemic approach can be seen as useful intervention for the presented problems (blaming and problem-saturated conversations)

• Potential mismatch: Problem severity and distress – preventative and low-intensive focus of service

• Need to adapt and improve training of family counsellors? Better screening procedures at client intake?

• ‘Stepped care system’: Need for a better local collaboration and referral system between low-intensive FC and CAMHS

Thank you! Questions?

Smith, H., Moller, N.P. & Vossler, A. (2016, in press).

Family therapy ‘lite’? How family counsellors conceptualise their primary care family work.

British Journal of Guidance & Counselling

(published online: http://dx.doi.org/10.1080/03069885.2016.1164296)

Vossler, A. & Moller, N. (2015).

‘We argue a lot and don’t talk with each other’: How distressed are families when seeking Relate family counselling?

Counselling and Psychotherapy Research, 15(1),12-20.