When kids or teens face conduct disorders, substance abuse, depression, anxiety, and eating disorders, family therapy may help.
That's the conclusion of Allan Josephson, MD, and colleagues. They studied a decade of research on family therapy.
In family therapy, one or both parents attend therapy with the troubled child. Other kids in the family don't have to attend.
"Most parents want the best for their kids," Josephson said in a media conference call. He says there is "abundant evidence" that family therapy can often make a big difference in six areas: conduct disorders, substance abuse, depression, anxiety, eating disorders, and understanding attention problems.
The report appears in the Journal of the American Academy of Child and Adolescent Psychiatry.
Conduct disorders are serious violations of age-appropriate behavior that often involve physical aggression, property destruction, and truancy, says Josephson. He works in the child and adolescent psychiatry division of the University of Louisville's medical school.
"There's no question that in this spectrum of family influence, conduct disorders clearly need family intervention and it's one of the more successful things when it's consistently applied," says Josephson.
Parents Step Up, Kid Takes Note
"It's very difficult to set limits without a child feeling secure," says Josephson. "Most clinicians that work very intensively with these problems will have a situation where a parent says, 'Fix the kid,' and the kid says, 'Well, why should I come in on time? Why should I stop using drugs? He or she has never done a damn thing for me.' I've had that quoted to me directly."
When the parent signs on for family therapy, that's a strong signal to the child, he notes. "The parent demonstrates their commitment to the child and the kid finally thinks, "Maybe I should go along with this,'" says Josephson.
Engaging parents in the treatment process and reducing the toxicity of the negative family environment can contribute to better treatment engagement, retention, compliance, effectiveness, and maintenance of goals, write the researchers.
Breaking Bad Cycles
Family therapy can sometimes show parents how to stop a vicious cycle with their kids.
Josephson recalls a father who admitted being "furious" when his eight or nine year-old son pestered him and acted out when he came home from work.
The dad "sat down with the paper, he took his beer, and he wanted to watch TV, tired from work. And guess what the kid did. He didn't disappear. He kind of badgered his father. He stood in front of the TV. And then guess what the father did? He yelled at him, he rejected him. The child then had nothing else to do but kind of act out a little more," says Josephson.
"With some basic work, we were able to help [the dad] see that that cycle was not helpful, that [the son] interrupting him was [because] he wanted some connection. He wanted some time with his father. [The dad] did that immediately, and the child had better things to do after they spent some time together. So that cycle was interrupted."
Family therapy helps kids quit using drugs, stay in drug treatment, and avoid related problems like truancy, says Josephson, citing "at least 12-14 well-designed studies."
Parents who strongly show disapproval of illegal drug use also helps, he notes. "This is what these public information announcements in the last few years of parents as the 'antidrug' are about," says Josephson.
Depression, Anxiety, Eating Disorders
Family therapy for kids with depression and anxiety has been studied for a shorter time, but results look promising so far, write the researchers. Several new studies suggest that family treatment or treatment augmented with family therapy is effective for depression and anxiety, they write.
Studies about eating disorders have shown patients successfully gain needed weight when family therapy is part of the program, though family conflicts sometimes increase.
"The nonverbal behavior organizing around food now becomes verbal. But that's essentially progress, although families sometimes have trouble believing it," says Josephson.
Dealing With Attention Problems
Family therapy doesn't relieve the core symptoms of kids' with attention deficit hyperactivity disorder. But it can help families understand and handle the condition better, according to the report.
Josephson says while interviewing a family, he once heard a six year-old boy tell his mom to shut up. "I looked at [the parents] and said, 'Am I the only one that's got a problem with this?' They looked me straight in the eye and said, 'Well, you know, he has attention deficit disorder.' I took the time to educate them that in fact I think he did [have ADD], but those behaviors -- in this case, disrespect ... and he was running the family, as you might guess -- was not necessarily accounted for by this central nervous system disorder."
Parents interested in family therapy should first get their child's condition diagnosed by a psychiatrist or well-trained psychologist, and kids' treatment may also require medication, notes Josephson.
SOURCES: Diamond, G. Journal of the American Academy of Child and Adolescent Psychiatry, September 2005; vol 44: pp 872-887. Allan Josephson, MD, division of child and adolescent psychiatry, department of psychiatry and behavioral sciences, University of Louisville School of Medicine. News release, American Medical Association.