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Autism in Systemic Group Psychotherapy: "Strong Together" a Care Model for Children and Adolescents from Practice Awareness of people with autism in our society is constantly increasing. Nevertheless, ambiguities and caution in dealing with autistic clients are still tangible. Due to the growing demand, there is a shortage of care for clients on the autism spectrum. This applies in particular to group therapy services in German-speaking countries. However, the international AWMF guidelines state that group therapy is the therapy method of choice for children and adolescents with autistic perception. In order to counteract this gap in care, this article presents a systemic group therapy for autistic people. It explains the extent to which the systemic approach in combination with a multimodal approach is a beneficial approach. It also highlights the importance of expanding the range of care services, interdisciplinary cooperation, and exchange. The compatibility of practice and research in systemic psychotherapy will be explained, teamwork in private practice will be emphasized, therapeutic experiences will be shared and an outlook on ongoing evaluation research will be presented.

Multifamilygroups as a Psychosocial and Contextoriented Intervention for Somatic Illness and Disability This paper provides a detailed description of a multi-family group (MFG) intervention designed for children with disabilities or chronical somatic disease and their families based on a systemic model. A mixed-methods study examines the perspectives of the participating family members regarding specific intervention components and the therapeutic process and its outcomes of this heterogeneous, closed MFG. Problem-centered interviews and questionnaires were used. Attendance of and satisfaction with the group were high. Specific intervention components such as the provided therapeutic environment and the mutual support that was facilitated by offering different opportunities for contact with families in similar situations are highlighted as particularly helpful. Increased feelings of parental togetherness and competence were reported. Results suggest that this MFG for families of children with chronic diseases or disabilities is highly feasible for these families.

Treatment Satisfaction of Mothers with Postpartum Depression Concerning Circle of Security Intervention Treatment satisfaction of mothers with postpartum depression who undergo mother-infant treatment is rarely examined, albeit seen as one aspect of treatment success. This study deals with maternal treatment satisfaction concerning the Circle of Security (COS) group intervention, compared to standard-mother-infant treatment (TAU), within a RCT trial. Treatment satisfaction was captured by the Fragebogen zur Beurteilung der Behandlung (FBB-E) of 52 mothers assigned to COS or TAU at children's age between 16 to 18 months. Process quality as well as outcome quality was assessed. Process quality included the evaluation of treatment procedure, information supply, evidence and justification of the measures undertaken, therapist's competence and coordination ability as well as the quality of relationship between therapist and mother. Results showed overall good to high and marginally different treatment satisfaction between both groups. COS-mothers declared themselves significantly more satisfied with the child (FBB-E-subscale: Success concerning the infant) than TAU-mothers. Both groups showed higher treatment satisfaction with the process quality than with the outcome quality of intervention. Overall, COS seem to meaningfully foster the acknowledgment of the child. In mother-infant treatment, particular attention is warranted to aspects of the process quality that attain the mother's treatment satisfaction.

Metacognitive Therapy and Pharmacotherapy - Adapted to Unaccompanied Refugee Minors Unaccompanied refugee minors (URM) present a relatively new challenge for adolescent psychotherapy and psychiatry. The evidence of possible treatment approaches is scarce. This paper presents a pragmatic adaptation of Wells' Metacognitive Therapy (MCT) for this population for the first time. Unlike the established trauma-focused treatment approaches MCT does not aim at prolonged exposure to the trauma narrative. Instead, patients shall learn to leave the distressing thoughts alone and to reduce the perseverating thinking processes (rumination and worrying). Adaptations to URM comprise preceding strategies of stabilization and culture specific aspects. In case of severe sleeping problems, medication might be of help.

Psychoeducational Group Interventions for Families with Parental Cancer Parental cancer constitutes a risk factor for the psychological development of all family members. Studies show that children as well as parents suffer losses in their quality of life and their psychological well-being and that participation in a psychological intervention results in an improvement of these parameters. This study examines two group interventions (children group for children with parents suffering from cancer; parental seminar for cancer patients and their partners) in comparison to a waiting group. The target parameters quality of life and psychological well-being of the three groups are compared on the basis of a variance analysis with repeated measurements with three measurement dates (pre, post and follow-up) and the intensity of effects (eta2) is being determined. Participants of the intervention groups show significant improvements in their values. The individual direct participants of the groups (children, parents) benefit most markedly from the interventions but also the other, non-participating family members show improvements in their parameters. The results also show that restrictions in the quality of life of the parents and children are not being reduced by themselves over time without intervention but remain evenly on a low level or are even being declined. Therefore, it is advisable to offer intervention to families with a parent suffering from cancer.

The Therapy Process of Accompanying Mothers in Multiple Family Therapy Groups: Evidence from a German Child Psychiatric Setting This study provides an empirical contribution to the understanding of parents that accompany their children in psychiatric multiple family therapy settings (MFT). To this end, we conducted qualitative interviews with mothers that had successfully participated, with their diagnosed children (ages 3 to 9), in disorder-independent, age-homogeneous, and open family groups (the "Magdeburg Model") for several months. We performed a theoretical coding approach to the extensive interview material (n = 6 interviews, duration = 70 to 100 minutes each) according to Grounded Theory and extracted seven main and 29 sub-categories. These categories yield a coherent, complete, and specific subjective therapy model for this setting. One of the central findings is a profound understanding of to what extent and by which means the family group as a social arena paves and supports the arrival of the mothers in the group, their engagement into the therapy process, and their motivational and volitional steps during therapy. Another relevant result is a reconstruction of what we termed Arriving Home, which is the epitome of the positive cognitive, affective, and behavioral therapeutic development that mothers perceive. Conclusions for clinical practice as well as for qualitative and mixed methods therapy research are discussed.

Multi-Family-Groups are an intervention setting, that is mainly applied in the context of systemic therapy and counselling. In this article we introduce some basics of that setting and sketch some specifics and two examples of use for the application in the context of youth welfare.

Excessive Internet use and its severe form, pathological internet use, are currently increasing in many industrial nations in Asia, North America and Europe. According to recent epidemiological studies pathological internet use occurs more frequently in youth than in adults. In Germany between 4 and 6% of the adolescents use the internet in a pathological way. Only few studies have investigated therapeutic interventions and their effectiveness in affected adolescents. In this pilot study, we surveyed over a period of 15 months all minor participants (aged up to 17) of a cognitive behavioural group programme at the beginning and at the end of the treatment (pre-post design) with standardized questionnaires (CIUS, SPS-J). At the second point of measurement the adolescents (n = 18, 75 percent retention rate) reported a significantly lower severity of problematic internet use as well as reduced average usage times during the week and at the weekend. No changes were revealed in psychological well-being of the youth. The results of this pilot study indicate positive effects of a cognitive behavioural group programme with psychoeducative elements in the treatment of youth affected by pathological internet use.

Eia Asen developed multi-family-therapy (MFT) in the context of pediatric psychiatric work with predominantly poor and marginalised families from very different cultural, religious, linguistic, and social traditions in inner-city London. This work began with families affected by globalisation, migration, segregation, criminality, and other adverse social and economic effects of Thatcherism. Asen replaced the expert-led diagnostics, patterns of illness and individual medical indication of the case-by-case based model of treatment with a systemic practice developed across decades together with a large multi-professional and multicultural team, which places the family, the social, economic, and educational contexts, as well as traditions and the every-day situations of children and their parents, at the centre of the support. MFT makes particular use of the mutual solidarity, willingness to help and competence of families in comparable situations. The article describes how the child-guidance service has transferred this concept of multi-family training to the outpatient (non-residential) educational support work of the Youth Welfare Department of Ludwigshafen, a medium-sized city with above average social risks. The successes of this pilot project across two-and-a-half years are encouraging and suggest the further development and expansion of this approach.

Multi-family therapy, common group therapy with several families per one index patient, has been gaining popularity recently. This has occasioned an exploratory study of the status of implementation and common factors in all multi-family therapy programs in Germany. In a survey conducted across Germany, all providers of multi-family therapy interventions were requested to give a detailed description of their intervention. Quantitative data were analyzed with descriptive statistics, and verbal data were summarized categorically with qualitative content analysis. Of the 25 intervention programs examined 21 are directed at emotionally disturbed children and young people and their families; mainly with disturbances in social behavior. Over 4,000 families per year are treated in multi-family therapy, and five programs were systematically evaluated. MFT is characterized by systematically oriented group therapy methods. Those surveyed traced the effect of this form of intervention back to activating problems in the group, activating resources, changing perspective, learning models, experiencing self-efficacy, and the therapeutic relationship. Systematic studies of multi-family therapy in evaluations and in random controlled study designs are recommended.

Severe feeding disorders often require inpatient treatment and need a holistic assessment and treatment approach. This article introduces some of the current literature concerning feeding disorders in infants and toddlers. The philosophy of the Department of Infant Psychosomatics at the University Children's Hospital Zürich emphasizes interdisciplinary teamwork, the application of psychodyamic tools in pediatric liaison psychiatry and utilization of group settings. Clinical approach and course of treatment are illustrated by three case reports, highlighting specific psychotherapeutic interventions with the parent-infant relationship in the context of a paediatric clinic.

Since the early sixties empirical research into early childhood and the parent-infant relationship has increased, commonly informed by attachment theory. The mutually regulated interaction within the attachment and care giving relationship of mother and infant gives this relationship its exceptional emotional quality. Early attachment experiences organize socio-emotional and cognitive development beyond childhood. Attachment theory and research define observable behaviors and the level of internal representations as an intervening variable of the transmission of attachment patterns between mother and child. Basic attachment derived concepts are the starting points of the Circle of Security approach. The Circle of Security Intervention Project in Hamburg for mothers with postpartum mental illness and their infants is described in more detail. Specific aspects are discussed with reference to a diagnostic case study.

Mentalization is the process by which we implicitly and explicitly interpret the actions of ourselves and others as meaningful based on intentional mental states (e.g., desires, needs, feelings, beliefs, and reasons). This process is disrupted in individuals with comorbid antisocial (ASPD) and borderline personality disorder (BPD), who tend to misinterpret others' motives. Antisocial characteristics stabilize mentalizing by rigidifying relationships within prementalistic ways of functioning. However, loss of flexibility makes the person vulnerable to sudden collapse when the schematic representation is challenged. This exposes feelings of humiliation, which can only be avoided by violence and control of the other person. The common path to violence is via a momentary inhibition of the capacity for mentalization. In this article, the authors outline their current understanding of mentalizing and its relation to antisocial characteristics and violence. This is illustrated by a clinical account of mentalization-based treatment adapted for antisocial personality disorder. Treatment combines group and individual therapy. The focus is on helping patients maintain mentalizing about their own mental states when their personal integrity is challenged. A patient with ASPD does not have mental pain associated with another's state of mind; thus, to generate conflict in ASPD by thinking about the victim will typically be ineffective in inducing behavior change.

A short description outlines the development of commission focused short-term therapy (AFoG) for children and adolescents. Subsequently the generic principles of psychotherapy are applied to AFoG in order to underline the basic assumptions of this variation of systemic group therapy. Behavioural changes arising in different contexts (school, family, group therapy) show the need for an appropriate flexibility of group therapy techniques. The evaluation was accomplished using the Child Behaviour Checklist (CBCL 4-18) at the beginning and 3 month after the end of the group therapy. The results show positive effects which finally are discussed critically.

Studies on the effectiveness of parent trainings, especially for children treated with stimulants, yielded conflicting results. This study investigated the effectiveness of parent training (PT) as a part of routine clinical care. Compared to a waitlist control (n=16) PT-mothers (n=16) reported significantly fewer ADHD-symptoms, better acceptance of their children and a trend to better relationship satisfaction. No differences were found between children treated with or without stimulants. Contrary to the high level of consumer satisfaction fathers didn't report any improvements on all outcome domains.

Multi-family Therapy (MFT) is an evidence-based method used in the treatment of psychological disorders, psychiatric symptoms and physical illness in children, adolescents and adults. It is widely used in Anglo-American countries. In Germany initial studies showed positive effects of MFT with adolescents with anorexia nervosa and children with learning disabilities. The Frankfurt multi-family Therapy model for families with children with developmental delays, chronic illness or disabilities has been in practice and constant development at the Frankfurt social pediatric center since 1994. A pilot study examined treated families assessment of the program's content, format, objectives and therapeutic effects. Results indicate a high level of acceptance of the involved families and positive effects on the intra-family and inter-family level. Furthermore, the Frankfurt MFT model could be shown to be an effective and appropriate mode of intervention, in particular for those families who have to cope with the special needs of their children throughout a lifetime.

Multifamily therapy is an evidence-based method used in the treatment and prevention of severe psychiatric disorders, behavioral problems and physical illnesses in children, adolescents and adults. For preventive family-oriented work with children with learning disorders there is a lack of therapeutic models. This article presents results from an innovative pilot project--multiple family groups for families with a learning disabled child of primary school age (six to eleven years old). Based on a systemic approach, this resource-oriented program integrates creative, activity-based interventions and group therapy techniques and conveys a comprehensive understanding of the challenges associated with learning disorders. Because of the pilot character of the study and the small sample size, the results have to be interpreted with care. The results do however clearly support the wider implementation and evaluation of the program in child guidance clinics, social-pediatric centers, as well as child and adolescent clinics and schools.

This article describes the practice of multi-family therapy in day care settings. Between six to eight families attend together for whole days and weeks and the principles and the methods of this approach are described and illustrated with examples of systemic work with children with severe behavioural and learning disorders, as well as with adolescents presenting with anorexia nervosa.

For most of us, songs and nursery rhymes have a special emotional quality and, thus, are part of the basic repertoire of a music therapist. This paper outlines the meaning and applicability of songs in music therapy with children. The first part discusses the significance of songs within the context of developmental psychology, referring to the development of basic psychological functions such as motorical skills, language, cognition, emotion, mental representations, motivation and intention. The second part deals with indications and objectives as well as different applications of songs in music therapy. Traditional and new nursery rhymes, free renderings, playing songs, spontaneous tunes, welcome and farewell songs and semi-structured tunes are introduced. Finally, the article reviews the diverse therapeutical functions of songs within the process of music therapy as well as essential qualifications for a music therapist.

We present an intensive outpatient group treatment for girls with eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder) additionally to/instead of inpatient treatment or individually treatment by psychotherapists. The therapy concept is primarily behaviour therapy oriented, encouraging the self-management-abilities of the patients thereby learning self-determination and responsibility in dealing with their illness. The slow-open group concept provokes group cohesion, solidarity and support among girls, who share similar age-related development-stages and eating disorders. Other than cognitive behaviour therapy and the principles of self-management we use client-centered therapy, art-, dance- and nutritional therapy. For each patient an individual treatment plan is adapted depending on age, individual symptoms, problems and motivation. Each member of the group has to accept defined group rules during the group sessions. The group takes place twice a week and on one Saturday per month. The adolescents stay in their social environment. Transfer of therapeutic success into daily life therefore is immediate and longlasting. Duration of therapy is between four months and one year, longer only in complex cases. Parallel to the parent/patient cooperation a parental psycho-educative group is available.

Parents of adolescents with eating disorders show high levels of emotional distress, which may contribute to less functional coping with the illness of their child. In our department a psychoeducational group program is been offered to the parents of 153 children and adolescents with anorexia and bulimia nervosa. According to their own reports parents are highly interested in gaining information about the eating disorder and appreciate this means of support to help them to cope with the illness of their child.

The purpose of this study consists in the investigation of the effectiveness of an Integrative Group Therapy involving children from a social focus area. The research has been made on a group therapy covering a total of 22 therapeutic sessions with six "marginalised children" aged seven to nine attending the second class of a primary school. The children suffered from considerable concentration and attention problems affecting their achievements at school. The dominating symptom with three of these children has been aggressiveness, with two of them it has been social withdrawal and insecurity and one child suffered from psychosomatic complaints. The success of the treatment was determined by different target areas (symptomatic features, adaptive function, individual therapeutic goals, assessment of the treatment), having been assessed by different persons of reference (parents, teachers, therapists). According to the results the effectiveness of the Integrative Group Therapy with children has to be regarded unsatisfactory. The average effect size (averaged over all the scales of CBCL and TRF) amounts to 0.32. Considering only those scales where there have been peculiarities at the preliminary measuring, the average effect size amounts to 0.39. According to the individual case evaluation the treatment may be considered successful with one child, yet with another child a definite negative development has been noticed, and with four of the children no or slightly positive changes have been registered. The Integrative Group Therapy seems to be inapplicable to children with aggressive problems. In conclusion the results will be discussed and proposals for an improvement of the treatment are being made.

In this study 14 children with different anxieties attended in small groups a cognitive-behavioral training program. The groups met once a week over a period of ten weeks. Outcome was evaluated with different questionnares for children and parents and interviews at the beginning and the end of training and ten weeks later. The different measures showed a significant reduction of self-reported anxiety. Anxious, avoident and social insecure behaviour was also reduced. Further the negative self-talk of the children changed into more appropriate positive self-talk. As it was not possible to use an appropriate control group, the results can just be seen as hints for the effectivity of a cognitive-behavioral orientated group therapy program for the treatment of various childhood anxieties. Further research under controlled conditions is necessary.

The authors have developed a group therapy model specifically for children who are difficult to treat using traditional psychotherapeutic techniques. In the present article they describe this model, which has been employed successfully for the past four years in an elementary school in an area of high social deprivation, in collaboration with teaching staff and a social worker.

Modern behavior therapy strategies which reduce aggressive behavior are based on developmental psychopathological assessments. These help to confirm intervention steps adapted to each specific age group. The extensive spectrum of methods in child behavior therapy offers different cognitive and social elements which are used to help the child effectively. The training for aggressive children by PeTERMANN and PeTERMANN (1994) which generally includes behavior-oriented family counselling shall be considered.

Group therapy with adolescents suffers from a lack of empirical studies although this specific therapeutic setting has been described in clinical reports as particularly beneficial. This article provides a survey of available controlled outcome- and process-studies in group therapeutic settings with adolescents covering publications up to 1992. Future research topics in adolescent group therapy investigations are being discussed while comparing results and questions of group therapy research with adult clientels and their possible application to research with adolescents in groups.

Through its setting, group psychotherapy with parents is particularly suited to supporting the parents of children in inpatient therapy in their own therapeutic process. The conception of such groups, which must take into consideration the difficult psychological situation of the parents involved, is integrated in three goals: The care of the relationship between parents and the clinic, supporting the parents' self-esteem, and encouraging their participation in the group process. The author asserts that the method known as interactional therapy is best suited for meeting these goals. Methodological building blocks are offered, and the group process is described utilizing case examples.

This article discusses group psychotherapy as a possible crisis intervention technique for children and juveniles with behavioral problems at school or whose families are going through divorce, or as an intervention technique in trouble some school classes. The therapeutic group work at the Children and Juvenile Educational Counselling Centre in Bern, Switzerland, is described - "mythodrama" or the "tales, fiction and horror technique", a therapeutic approach which was developed during the last couple of years. The tale at the beginning of the article serves as an introduction and is followed by a description of the different phases of mythodrama. Finally, the main elements of this approach are summarized.

Following a discussion of fundamentals of psychoanalytically oriented art therapy, clinical examples are shown to illustrate its practical application within the field of adolescent group psychotherapy. The mutually stimulating and complementing possibilities of expression within the creative process, the art works themselves and the verbal interaction offer a concrete, yet very flexible opportunity for dealing with group activity, transference, individual conflicts and difficulties within the developmental tasks of adolescence.

This article describes a group project involving educational-therapeutic work on an inpatient basis with behaviourally disturbed adolescents. It shows how the integration of education and therapy, which is considered so necessary at the inpatient level, is achieved in group therapy and it describes as well the institutional framework within which the group project is carried out, as well as the type of practical experience with behaviourally disturbed adolescents which preceded the development and application of the group therapy work. The initial conditions, aims and the development process of the group therapy which took place over a period of two years are presented and four development phases are identified and explained. The article ends with observations concerning the self-evaluation of the group leaders, the general experience gained in the setting up of educational-therapeutic group work with behaviourally disturbed adolescents and a review of the preliminary results of the group project.

The paper reports about some aspects of a major retrospective case study of 43 psychotic adolescents in long term in-patient treatment. One of five items to classify these treatments were rapidly changing ego-states. In 17 patients this phenomenon was seen as having essential repercussions on the therapeutic course. The discussion is centered round the day by day interactions with these patients on the ward. The question is raised, how holding structures and continuity of personal relations can be reached and maintained in view of rapidly changing levels of ego functioning. Much emphasis is laid on the understanding of interpersonal dynamics between nursing staff and patients. Such understanding enables the team to adapt to the patients' needs without being overwhelmed by their impact. A thus reflected shaping of everyday interactions on the ward is highlighted as an essential factor in the treatment of psychotic adolescents. The term "rapidly changing ego-states" refers to the adolescent problem of maturation and separation and to the restating of this problem in a treatment setting. Mental illness evolves to be understood a developmental crisis.