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Monica McGoldrick stands as a towering figure in the field of family therapy. Initially earning a Masters in Russian Studies, she then pivoted to social work and systems thinking. McGoldrick's illustrious career has been marked by significant contributions to family therapy, particularly through her work with family genograms, mapping family relationships and histories to identify patterns across generations. She expanded the use of genograms to incorporate cultural, ethnic and gender contexts, revolutionising the field. Her work emphasises understanding individuals within their historical, social and cultural contexts. She has authored multiple seminal texts, including ‘Ethnicity and family therapy’, and Genograms: Assessment and treatment, which are essential reading in family therapy training. McGoldrick has also been a trailblazer in addressing issues related to gender and power in family therapy. In this candid interview, she contextualises and frames her experience in a historical scaffold at a pivotal time in the evolution of family therapy. Monica details her involvement in the development of important endeavours such as the Multicultural Family Institute and the Women of Stonehenge where she emphasises the vital role of women in our community and the profound contribution of women in our profession, often dismissed and undervalued. We also discuss her notable contribution in the development and expansion of family genograms where she highlights the central and fundamental role of culture. [ABSTRACT FROM AUTHOR]

This article aims to apply structural family therapy to working with family and intimate partner violence in after-violence context, where risks and safety issues have been addressed. This practice research study uses case analyses based on the work done with a Chinese couple and a Chinese family in Singapore, respectively. It identifies the salient therapeutic focus and healing processes in after-violence context with Chinese families. Reflections and feedback of social workers and clients during and after the conjoint sessions were included systematically. Practice implications to apply Structural family therapy in working with Chinese couples and families in after-violence are highlighted. [ABSTRACT FROM AUTHOR]

Previous research on African Americans' engagement in family therapy has focused on barriers to treatment. This qualitative study examines the experiences of African Americans who choose to attend family therapy. We utilized a pattern second cycle coding process to analyze survey data from 39 African American adults who attended family therapy. The findings generated five themes that describe the participants' experiences that brought them to family therapy, (1) life experiences that led to family therapy, (2) perceptions of therapy, (3) positive experiences that encouraged participants' use of family therapy, (4) factors that caused participants hesitancy in attending family therapy, (5) change in perception concerning family therapy. The final theme was generated by exploring participants' perceptions of family therapy before and after engaging. Thirty-four participants reported positive beliefs about therapy after receiving family therapy. In addition, participants' coping mechanisms before entering therapy are detailed to provide insights into how they managed issues before deciding to engage in family therapy. We offer recommendations for engaging African Americans in family therapy and implications for future research. [ABSTRACT FROM AUTHOR]

Although structural strategic family therapy (FT) is an evidence-based approach for adolescent behavior problems, manualized family therapy models have not been widely adopted in usual care due to the training and implementation resources required. This article presents a competency framework for utilizing family collaboration with adolescent cases. It begins by discussing challenges to implementing FT in routine care and presents the core elements strategy, then introduces three "branches" that together constitute a continuum of family involvement—family collaboration, family skills training, and systemic family therapy—and describes the rationale and procedures for focusing on competency guidelines for family collaboration specifically. It then describes the basic techniques and competency guidelines for six core elements of family collaboration: family systems outreach, adolescent ecosystem, location of self, goal setting, family participation, caregiver consultation, family session management. It concludes by discussing future directions for this framework and the development of additional competencies for the other branches. While further research is necessary to test the efficacy of the treatment branches and accompanying competency standards, this article presents an innovative approach to involving family members in care that includes accessible competency guidelines. [ABSTRACT FROM AUTHOR]

Panic disorder (PD) affects family members and can be influenced by familial factors. Adverse family events may contribute to anxiety and PD. We examined a family therapy case of a client with PD in South Korea. We used a thematic analysis to analyze therapy transcripts and video recordings and displayed our findings using a network. We identified five stages of the psychological process in the development of PD: (1) formation of anxiety, (2) sheltered life, (3) crisis, (4) loss of haven, and (5) inner breakdown. External situations, family dynamics, and psychological experiences at each stage are examined. Family dynamics that occurred as the family coped with external situations contributed to the client's psychological experiences, which triggered anxiety that led to PD. This study suggests family dynamics can be associated with one's internal experiences that could lead to PD, highlighting the importance of functional family dynamics and coping when facing crises. [ABSTRACT FROM AUTHOR]

Neurodevelopmental disorders affect the lifespan of diagnosed individuals and their families. COVID-19 challenged these families with daily routine unpredictability requiring rapid adaptations. Moreover, associations and schools were closed, leaving these families without regular social support. Here, we investigate which individual and family factors can predict the caregiver's depressive state and overall burden. An online study took place between 2021 and 2022. A total of 32 caregivers (30 women; 48 ± 8.22 years old; range 26 to 63 years old) reported having a family member with a neurodevelopmental disorder, the majority diagnosed with autism spectrum disorder. Caregivers responded to a protocol to assess the burden, resilience, depressive, anxious, and stress symptomatology, as well as the behavior of the diagnosed individual. Hierarchical multiple regressions were performed to identify protective and risk factors for the caregivers' well-being. Caregivers' depressive statewas explained by 29.3% of the variance of the family cohesion factor, indicating that high levels of balanced family cohesion represent a crucial protective factor for reducing the caregiver's depressive state. Additionally, overall caregiver burden was explained by 17.8% of the variance due to self-perception and 26.4% due to family cohesion, with the caregiver's self-perception playing an important protective role in the overall perception of burden. The proportion of male and female respondents seems to corroborate the significant role of women in caregiving. These results emphasize the importance of considering both individual and family factors of caregivers during interventions, which have implications for family therapy with families of members diagnosed with neurodevelopmental disorders, specifically with autism. [ABSTRACT FROM AUTHOR]

The shared loss of a child can present challenges to couple relationships as both partners attempt to cope with their own grief and their partner's grief. In this longitudinal qualitative study, five bereaved parent couples participated in 13 total interviews, revealing coregulatory interactions surrounding their shared loss. Using thematic coding and grounded theory analysis, their reflections were organized into three interrelated process themes: regulating self, regulating other, and forming our grief rhythm. This article explores the complexity of the last theme “forming our grief rhythm” in‐depth, and a new theoretical orientation, the relational window of tolerance, is introduced to examine how couples coregulate both fragile and stable states within their shared grief. The reflections of bereaved parents indicated that prolonged “dual fragile states” and prolonged “imbalanced states” may hinder relationship quality. In order to regain relationship stability, couples learned to trade off supporting one another and/or to resonate with one another in their shared pain. Implications for future research and clinical practice are discussed, focusing especially on how to integrate individual and relational needs into grief therapy frameworks. [ABSTRACT FROM AUTHOR]

In this paper, we report on findings from a three‐part enquiry into the essence of working with families of origin where all members are adult. Findings, in conversational form, describe the nature of adult family ruptures encountered, pathways to repair and unique factors associated with the therapeutic encounter with adult families relative to those with still dependent children. In exploring emergent themes, we hoped to come to some understandings of the models and unique skill sets that characterise and enhance family therapy with adult families. We found that, unlike families with younger children, adult children are often the more motivated sub‐system and indeed the drivers of a referral for therapy. The therapeutic focus centred around legacy work from prior unresolved family traumas or disrupted developmental processes. Features of the therapeutic process included supporting new and more proportional narratives about ingrained wounds, together with redefinition of caregiving relationships and a future gaze towards becoming an independent yet connected family structure. We consider the therapist's posture in validating the adult child's experience, contextualising parent histories and clearing emotional barriers that block healthy giving and receiving of care. Key decision points in the therapist's work included how to balance the past context of the rupture with its current legacy, and the place of exoneration versus forgiveness in the progression towards secure individuation. Findings may help refine therapeutic methods in the application of systemic therapies with adult family forms, particularly on the intersection with the adult mental health system. [ABSTRACT FROM AUTHOR]

Eating Disorders are psychiatric conditions that can manifest clinically as malnutrition due to restrictive eating and weight control behaviors or obesity due to binge eating. Eating disorders such as anorexia and bulimia nervosa have peak onset during adolescence and young adulthood. This population is at the highest risk due to psychosocial changes surrounding identity development and body image that occurs during this life-stage. Though binge eating disorder and avoidant/restrictive food intake disorder are not characterized by body image overvaluation, peak onset is also during adolescence and young adulthood. [ABSTRACT FROM AUTHOR]

Objective: To synthesise young person and family member perspectives on processes of change in family therapy for anorexia nervosa (AN), including systemic family therapy and manualised family-based treatments, to obtain an understanding of what helps and hinders positive change. Method: A systematic search of the literature was conducted to identify qualitative studies focussing on experiences of therapeutic change within family therapies for AN from the perspectives of young people and their families. Fifteen studies met inclusion criteria and underwent quality appraisal following which they were synthesised using a meta-synthesis approach. Results: Six overarching themes were generated: "A holistic focus on the young person's overall development"; "The therapeutic relationship as a vehicle for change"; "The therapist's confinement to a script and its impact on emotional attunement"; "A disempowering therapeutic context"; "Externalisation of the eating disorder (ED)"; and "The importance of family involvement". Positive change was helped by understanding and support given to the young person's overall development including their psychological, emotional, social and physical wellbeing, positive therapeutic relationships, relational containment within the family system and externalising conversations in which young people felt seen and heard. Positive change was hindered by inflexibility in the treatment approach, counter-effects of externalisation, negative experiences of the therapist, a narrow focus on food-intake and weight, as well as the neglect of family difficulties, emotional experiences, and psychological factors. Conclusions: Positive change regarding the young person's eating-related difficulties ensued in the context of positive relational changes between the young person, their family members, the therapist and treatment team, highlighting the significance of secure and trusting relationships. The findings of this review can be utilised by ED services to consider how they may adapt to the needs of young people and their families in order to improve treatment satisfaction, treatment outcomes, and in turn reduce risk for chronicity in AN. Plain English summary: This review synthesises the views of young people and their family members regarding their perspectives of therapeutic change within family therapies for Anorexia Nervosa (AN), including both manualised eating disorder-focussed family therapy models (family-based treatment; FBT and AN-focussed family therapy; FT-AN), as well as systemic family therapy (SyFT), to understand which aspects of these treatment approaches are helpful versus hindering to recovery from an eating disorder (ED). Parental involvement was crucial in facilitating the restoration of physical health through the process of parents taking temporary responsibility for the young person's eating behaviours until they can feed themselves again. However, treatment often failed to acknowledge and address the psychological and emotional difficulties that made the young person vulnerable to developing AN, as well as the psychological distress caused by increasing food-intake and weight. A positive therapeutic relationship in which families felt well supported by their therapist was important in providing containment during a time of familial strain and instability, yet there was a need for greater flexibility and individualisation within manualised ED-focussed family therapy approaches, particularly FBT. The findings highlight the importance of eliciting the young person's voice to enhance their personal agency in treatment and the value of therapeutic space to improve family functioning and enhance family unity. Lastly, they illuminate the need for manualised ED-focussed family therapy models to allow space for the therapist to emotionally attune to young people and families in order to contain their experience of distress. [ABSTRACT FROM AUTHOR]

There is a paradoxical paradigm operating in neurodiverse families with autistic children, indicating increased stress alongside enrichment of family life. An emerging body of research has shown that the use of family therapy can improve family functioning and relationships in neurodiverse families. The current study uses constructivist grounded theory to explore clinicians' experiences and perceptions of utilising family therapy in the context of autism. Study findings suggest that clinicians integrate therapeutic techniques from diverse family therapy approaches to improve family relations by bridging different ways of learning and communicating as well as facilitating multiple perspectives. Integrating therapeutic techniques across diverse approaches further encompasses working with the systems around the individual with autism. To adapt family therapy in the context of autism, it is suggested that clinicians examine their own perspectives and beliefs about autism and keep a curious stance during the process. [ABSTRACT FROM AUTHOR]

Background: Multi-family Therapy (MFT) is being increasingly used in specialist eating disorder services internationally. Despite evidence of its efficacy, little is understood about the treatment mechanisms and what specifically promotes change. This study aimed to understand clinician perspectives on how change occurs during MFT. Methods: Clinicians with (a) 5 or more years' experience facilitating MFT and (b) who had facilitated a minimum of two MFT groups were eligible for this study. Two individual interviews and four semi-structured focus groups were conducted online. Recordings were transcribed verbatim and analysed using reflexive thematic analysis. Results: Twelve clinicians (five systemic/family psychotherapists, five clinical psychologists, and two consultant child and adolescent psychiatrists) from six different specialist services in the UK participated. Four main inter-connected themes describing how change is perceived to occur were generated; (1) Intensity and immediacy, (2) Flexibility, (3) New ideas and channels of learning and (4) Containment. Conclusions: Current data matches closely with young person and parent experiences of MFT and intensive day treatment and how they perceive change to occur. Quantitative data are now needed to evaluate the impact of these factors on outcome. Plain English Summary Multi-family Therapy (MFT) is being increasingly used in specialist eating disorder services internationally. While there is evidence that it is helpful, little is understood about how the treatment works and what specifically promotes change. This study aimed to understand how clinician believe change to occur during MFT for young people and their family members. Clinicians with (a) five or more years' experience facilitating MFT and (b) who had facilitated a minimum of two MFT groups were eligible for this study. Two individual interviews and four semi-structured focus groups were conducted online. Recordings were written out word-for-word and analysed using reflexive thematic analysis, a commonly used method for analysing this type of data. Twelve clinicians (five systemic/family psychotherapists, five clinical psychologists, and two consultant child and adolescent psychiatrists) from six different specialist services in the UK participated. Four related themes describing how change is perceived to occur were generated; (1) Intensity and immediacy, (2) Flexibility, (3) New ideas and channels of learning and (4) Containment. Current data matches closely with young person and parent experiences of MFT and intensive day treatment and how they perceive change to occur. These factors now need to be tested in future research. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Discussion Trial Registration To systematically review and evaluate the efficacy of eating disorder focused family therapy (FT‐ED) in comparison to all other forms of psychotherapy for children and adolescents with anorexia nervosa. A secondary aim is to assess the relative efficacy of different variations of FT‐ED (e.g., shorter vs. longer dose, parent‐focused).A search with relevant terms was systematically conducted on four databases. Twenty‐three publications across 18 randomized controlled trials met inclusion criteria. Outcomes of interest included variables related to weight, eating psychopathology, and remission status. Study quality was assessed, and data were extracted by two independent researchers.Adolescents receiving FT‐ED gained significantly more weight by the end of treatment in comparison to those receiving individual psychotherapy. FT‐ED that was delivered just to parents or to parents and child separately offered preferable weight outcomes and rates of recovery at the end of treatment in comparison to conjoint FT‐ED. No other outcomes tested in the meta‐analysis were statistically significant at the end of treatment or follow‐up.Currently available data suggest the use of FT‐ED in its conjoint or separated/parent focused format is the best outpatient treatment option for adolescents with anorexia nervosa when immediate weight gain is paramount. The variability of outcome measurement, including the tools used and timepoints chosen, limit comparison among no more than a handful of studies. The field would benefit from the standardization of measurement and reporting guidelines for future clinical trials.PROSPERO number: CRD42023396263. [ABSTRACT FROM AUTHOR]

This paper serves as a preliminary presentation of an existential family therapy approach. It is based on presentation delivered at the Fifth European Conference for Existential Therapy, held in Istanbul on May 2024. Existential family therapy is a therapeutic approach that aims to integrate existential psychotherapy with foundational principles of family therapy. It is a work in progress with important implications for clinical practice and future research. [ABSTRACT FROM AUTHOR]

Women who have experienced conflict‐related sexual violence report significant long‐term effects, including posttraumatic stress disorder (PTSD), depression and relationship difficulties. Research has demonstrated that maternal trauma is associated with children's behavioural difficulties and challenges in family functioning, such as impaired communication and harsh parenting. This pilot study is aimed at evaluating the preliminary effectiveness of family therapy for Kosovar mothers who experienced conflict‐related sexual violence in 1998–1999 and later developed PTSD and their children in improving family functioning and reducing behavioural difficulties in postwar times. Sixty‐four mothers were randomised to an intervention group or a waitlist control group. Data was collected during a screening phase, at baseline before intervention initiation, after the intervention group completed family therapy and once the waitlist control group received the intervention. Generalised linear mixed models were used to analyse group differences in family functioning and children's behaviours over time. At follow‐up, mothers in the intervention group reported improved family functioning. However, mothers in the waitlist control group reported significantly fewer behavioural difficulties than mothers in the intervention group before the control group had started family therapy. There was no significant interaction between group condition and time for child‐rated family functioning. Overall, this pilot study suggests that family therapy could be effective in reducing the effects of intergenerational trauma related to PTSD and conflict‐related sexual violence. Future research should evaluate the long‐term effects of family therapy to assess if immediate effects were maintained. [ABSTRACT FROM AUTHOR]

At some point prior to their children turning 18, roughly 70% of mothers will hold the position of breadwinner in their family. The increasing number of breadwinning mothers is reflective of the shifting roles of women in families. Although a family role shift is evident for mothers, the centrality of women in the development of families across the lifespan remains unchanged. The centrality of mothers to family development is obvious in the family life cycle. Embedded in the traditional family structure, the family life cycle is a commonly used assessment model for family lifespan development despite its incongruence with professional counseling ethics and curriculum standards. The incongruence highlights the need for a family development model appropriate for diverse family structures. Therefore, a pilot case study approach guided this study as an initial exploration into the family development of high achieving women. An in-depth semi-structured interview with a single participant was conducted and then analyzed using a phenomenological approach. Four themes emerged from the participant's experience: self-efficacy and hustle, supportive relationships, resources used, and barriers faced. The findings from this study demonstrated a clear need for additional research. Additionally, the researcher recommends that counselor educators and family counselors should be cautious in their utilization of existing family development assessment models with diverse families. [ABSTRACT FROM AUTHOR]

Abstract Background Multi-family Therapy (MFT) is being increasingly used in specialist eating disorder services internationally. Despite evidence of its efficacy, little is understood about the treatment mechanisms and what specifically promotes change. This study aimed to understand clinician perspectives on how change occurs during MFT. Methods Clinicians with (a) 5 or more years’ experience facilitating MFT and (b) who had facilitated a minimum of two MFT groups were eligible for this study. Two individual interviews and four semi-structured focus groups were conducted online. Recordings were transcribed verbatim and analysed using reflexive thematic analysis. Results Twelve clinicians (five systemic/family psychotherapists, five clinical psychologists, and two consultant child and adolescent psychiatrists) from six different specialist services in the UK participated. Four main inter-connected themes describing how change is perceived to occur were generated; (1) Intensity and immediacy, (2) Flexibility, (3) New ideas and channels of learning and (4) Containment. Conclusions Current data matches closely with young person and parent experiences of MFT and intensive day treatment and how they perceive change to occur. Quantitative data are now needed to evaluate the impact of these factors on outcome. Plain English Summary Multi-family Therapy (MFT) is being increasingly used in specialist eating disorder services internationally. While there is evidence that it is helpful, little is understood about how the treatment works and what specifically promotes change. This study aimed to understand how clinician believe change to occur during MFT for young people and their family members. Clinicians with (a) five or more years’ experience facilitating MFT and (b) who had facilitated a minimum of two MFT groups were eligible for this study. Two individual interviews and four semi-structured focus groups were conducted online. Recordings were written out word-for-word and analysed using reflexive thematic analysis, a commonly used method for analysing this type of data. Twelve clinicians (five systemic/family psychotherapists, five clinical psychologists, and two consultant child and adolescent psychiatrists) from six different specialist services in the UK participated. Four related themes describing how change is perceived to occur were generated; (1) Intensity and immediacy, (2) Flexibility, (3) New ideas and channels of learning and (4) Containment. Current data matches closely with young person and parent experiences of MFT and intensive day treatment and how they perceive change to occur. These factors now need to be tested in future research.

Abstract Objective To synthesise young person and family member perspectives on processes of change in family therapy for anorexia nervosa (AN), including systemic family therapy and manualised family-based treatments, to obtain an understanding of what helps and hinders positive change. Method A systematic search of the literature was conducted to identify qualitative studies focussing on experiences of therapeutic change within family therapies for AN from the perspectives of young people and their families. Fifteen studies met inclusion criteria and underwent quality appraisal following which they were synthesised using a meta-synthesis approach. Results Six overarching themes were generated: “A holistic focus on the young person’s overall development”; “The therapeutic relationship as a vehicle for change”; “The therapist’s confinement to a script and its impact on emotional attunement”; “A disempowering therapeutic context”; “Externalisation of the eating disorder (ED)”; and “The importance of family involvement”. Positive change was helped by understanding and support given to the young person’s overall development including their psychological, emotional, social and physical wellbeing, positive therapeutic relationships, relational containment within the family system and externalising conversations in which young people felt seen and heard. Positive change was hindered by inflexibility in the treatment approach, counter-effects of externalisation, negative experiences of the therapist, a narrow focus on food-intake and weight, as well as the neglect of family difficulties, emotional experiences, and psychological factors. Conclusions Positive change regarding the young person’s eating-related difficulties ensued in the context of positive relational changes between the young person, their family members, the therapist and treatment team, highlighting the significance of secure and trusting relationships. The findings of this review can be utilised by ED services to consider how they may adapt to the needs of young people and their families in order to improve treatment satisfaction, treatment outcomes, and in turn reduce risk for chronicity in AN.

Objectives: The high prevalence of borderline personality disorder, along with comorbid psychiatric disorders and impulsive reactions (suicide attempts, self-mutilation, substance use, and impulsive behaviors) increase the need for effective psychological interventions. In this study, the effectiveness of dialectical behavior skills training based on the Soler method and family education with individual therapies are compared in this group of patients. Methods: In this single-blind case study, eight cases were selected through a targeted sampling method based on the inclusion and exclusion criteria. The participants were divided into two groups: Intervention individually and individual intervention with family education. Both group members and the family members of the second group received dialectical behavior skills training based on the Soler model. The participants completed the borderline personality inventory, self-harm inventory, and Barratt impulsivity scale in four stages: At the beginning of the sessions, in the middle of the treatment, at the end of the treatment, and three months after treatment. Results: The data were analyzed using the Wilcoxon test, Friedman test, and Mann-Whitney U test. The results indicate the effectiveness of the dialectical behavior skills training method based on the Soler model in reducing symptoms of borderline personality disorder and self-mutilation, as well as emotion regulation improvement at the significant level of P=0.05. Discussion: This treatment is recommended as an effective and short-term method for controlling symptoms of borderline personality disorder. Family education, in addition to dialectical behavior therapy, has been shown to have a positive effect on reducing symptoms in patients.

Family violence is becoming increasingly visible in Australia, with many state and federal governments taking on more responsibility to address family violence and its impacts on those affected. Current efforts are focused on practice frameworks, identifying and responding to risk factors, and social justice frameworks including legislating against family violence in a range of jurisdictions and addressing more broadly the structural and cultural forces that perpetuate violence and further oppress those victimised. Family violence is not unique to Australia, with prevalence rates internationally suggesting family violence occurs irrespective of country, race, age, culture, effectiveness of social policies or socioeconomic status. This paper explores relevant foundational concepts of Bowen family systems theory (BFST) as it relates to family violence and explores opportunities to evolve practice in this area. BFST offers a unique contribution towards addressing family violence, particularly in relation to the public health challenge of addressing family polyvictimisation. The paper also explores how BFST conceptualises family violence and the role of the professional in working with the family as a single emotional unit. The unique focus of BFST on observing and defining self within the emotional family unit through observation of the underlying multigenerational emotional patterns of functioning provides unique opportunities to evolve and develop both the capacity of clinicians and responses to families who are navigating the serious and challenging impacts of family violence. [ABSTRACT FROM AUTHOR]

Dr Murray Bowen, developer of Bowen family systems theory (BFST), had this to say to clients about working in family systems: if you get bogged down in one area, move into another (Bowen & Kerr, 1985). This statement, along with the knowledge of BFST, offered an inspiration for thinking about a method of therapy. This article highlights a method of working with an individual through a systemic lens. Two ideas are integral to this focus. One is that a client can move more easily into observing self within the system when they are not just observing self in one context or relationship but rather looking at how they function in different contexts or relationships. And second, by moving into different contexts of the system, the therapist is better able to manage the tendency towards symptom focus and stay centred on the work of differentiation. A therapist can truly have a stadium view of the system when speaking with the client about how they function in different areas of life. This method defined happens in three phases: in phase 1, the client observes themselves in their system in different contexts and looks for patterns in their functioning; in phase 2, the client takes this new self‐recognition and experiments with different ways of being in one context; and in phase 3, the insights gained from experiments in one context are applied in other contexts. Both client and clinician will benefit from less symptom focus and increased ability to observe patterns in relationships, both of which are core tenets of the work of differentiation in BFST. [ABSTRACT FROM AUTHOR]

This paper overviews Bowen family systems theory and its approach to family therapy. It aims to introduce this influential approach and a sample of developments in theory and practice since Bowen's first publications of his research and theory. This paper is the second edition of a 1999 article with the same title (Brown, Australian and New Zealand Journal of Family Therapy, 20, 94 and 1999) and, 25 years later, offers new insights from the original author's ongoing research into the theory. This new edition is in collaboration with a second author and Bowen theory scholar, bringing fresh perspectives on the theory's applicability to family therapy practice. The core concepts are presented briefly, and a case example with a parent and symptomatic adolescent demonstrates how theory informs the role of the therapist and the therapeutic work. Examples of criticisms of Bowen theory are also discussed, including the misinterpretation around the idea of emotion in Bowen theory that is communicated in Gottman's training. Differentiation of self is clarified as the integration of emotion and intellect rather than privileging one over another, which affords the opportunity for individuals to avoid being governed by the invisible strings of sensitivities in relationships and instead be themselves in good emotional contact with the other person. [ABSTRACT FROM AUTHOR]

Anti‐Black racism including structural racism and racism‐related disparities have come to the foreground in recent years with the increasingly frequent and brutal police killings of innocent African Americans, the disproportionate impacts of the pandemic on the Black community, and the effectiveness of the Black Lives Matter movement. There have been calls to action to ensure cultural effectiveness of couples and family therapy for African Americans. As one response to these calls, this article provides recommendations for culturally humble and anti‐racist couple and family interventions. These best practices focus on the necessity of embracing a systemic stance and a strengths‐based culturally responsive lens when assessing and intervening with African American couples and families. They focus on the need for therapists to be intentional about and consistent in engaging in self‐exploration and taking the necessary steps to be not just competent but also capable. The final set of best practices detailed relate to assessing and intervening using a strengths‐based approach in a culturally responsive, anti‐racist, and socially attuned fashion. The article concludes with recommendations for couple/family therapists to develop a critical consciousness, engage in anti‐racist practices, and address oppression while advancing healing and liberation, all of which are essential to ensuring the resilience and well‐being of African American couples and families. [ABSTRACT FROM AUTHOR]

Objectives: The high prevalence of borderline personality disorder, along with comorbid psychiatric disorders and impulsive reactions (suicide attempts, self-mutilation, substance use, and impulsive behaviors) increase the need for effective psychological interventions. In this study, the effectiveness of dialectical behavior skills training based on the Soler method and family education with individual therapies are compared in this group of patients. Methods: In this single-blind case study, eight cases were selected through a targeted sampling method based on the inclusion and exclusion criteria. The participants were divided into two groups: Intervention individually and individual intervention with family education. Both group members and the family members of the second group received dialectical behavior skills training based on the Soler model. The participants completed the borderline personality inventory, self-harm inventory, and Barratt impulsivity scale in four stages: At the beginning of the sessions, in the middle of the treatment, at the end of the treatment, and three months after treatment. Results: The data were analyzed using the Wilcoxon test, Friedman test, and Mann-Whitney U test. The results indicate the effectiveness of the dialectical behavior skills training method based on the Soler model in reducing symptoms of borderline personality disorder and selfmutilation, as well as emotion regulation improvement at the significant level of P=0.05. Discussion: This treatment is recommended as an effective and short-term method for controlling symptoms of borderline personality disorder. Family education, in addition to dialectical behavior therapy, has been shown to have a positive effect on reducing symptoms in patients. [ABSTRACT FROM AUTHOR]

AbstractThe article examines the relationship dynamics among families who were uprooted from their traditional communities because of conflict in Marawi City in the southern Philippines. The study specifically explores the areas of family communication, family intimacy, and family conflict domains in households of internally displaced persons (IDPs). Data were drawn from 266 IDP marital couples through an assisted survey. Through statistical comparisons, the study was able to establish that the frequency and quality of communication and intimacy patterns fell while family conflict increased. A t-Test also indicates the decreased trajectory of the quality of familial relationship in displacement compared to prior displacement. These results underpin the fact that war harms family harmony. The study argues that the government, through their social welfare offices, being at the forefront of social care intervention, should consider providing family therapy as a specific assistance to IDPs. More than ensuring a strengthened family bond, the benefit of undergoing family therapy is vital because it may have implications for the pace by which IDP families build back better. Future studies may explore the effectiveness of family therapy intervention to strengthen its place in the social services arena in the context of internal displacement. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionThis meta-analysis evaluates the efficacy of systemic therapy approaches on adult clients with depressive disorders.The illness-specific systematic review updates a previous meta-analysis on the efficacy of systemic therapy on psychiatric disorders in adulthood. It integrates the results of 30 randomized controlled trials (RCTs) comparing systemic psychotherapy for depression with an untreated control group or alternative treatments. Studies were identified through systematic searches in relevant electronic databases and cross-referencing. A random-effects model calculated weighted mean effect sizes for each type of comparison (alternative treatments, control group with no alternative treatment/waiting list) on two outcomes (depressive symptoms change, drop-out rates).On average, systemic interventions show larger improvements in depressive symptoms compared to no-treatment controls at post-test (g = 1.09) and follow-up (g = 1.23). Changes do not significantly differ when comparing systemic interventions with alternative treatments (post-test g = 0.25; follow-up g = 0.09). Results also vary, in part, by participant age, publication year, and active control condition.This meta-analysis indicates the potential benefits of systemic interventions for adult patients with depression. Future randomized clinical trials in this area should enhance study quality and include relational and other relevant outcome measures. [ABSTRACT FROM AUTHOR]

AbstractOCD can be highly distressing for both individuals and families. While evidence for the effectiveness of family-based treatments has grown, literature lacks discussion of best practices for systemically addressing family accommodation (FA) and other family factors in OCD treatment. This paper aims to integrate best practices from individual and systemic models of therapy for adolescent OCD and to further discussion on the application of MFT-based models. This discussion is oriented by Sue & Sue’s (2002) conceptualization of clinical competence on therapist knowledge, awareness, and skills to support effective systemic treatment for this population. [ABSTRACT FROM AUTHOR]

• Family-based treatment (FBT) is a potentially effective method for treating adolescents with binge-eating disorder (BED) • Full remission of eating disorder symptomatology was achieved with FBT. • FBT allows family-level factors to be addressed in treatment. Family-based treatment (FBT) is considered the treatment standard for adolescent anorexia nervosa and bulimia nervosa—however, the effectiveness of FBT for adolescents with binge-eating disorder (BED) has not been evaluated. This clinical case paper presents the case of BED in an adolescent female treated with FBT. Through the use of FBT, family weight bias was addressed in sessions by the multidisciplinary team. Empirically supported survey measures were analyzed to monitor treatment outcome. After 21 weeks of treatment, eating disorder symptoms were in remission. In addition, the use of FBT allowed for family factors to be addressed in treatment that may have been overlooked in individual treatment. This led to a reduction in weight and food-based shame within the family unit. As indicated by this case, FBT may be an effective treatment for adolescent BED, and as such, an effective treatment approach for adolescents across the eating disorder spectrum. Further research is needed to understand the effectiveness of FBT for BED. [ABSTRACT FROM AUTHOR]

Eating disorders are serious psychosomatic disorders and constitute the most common chronic disorder of female adolescence. Men experience a later onset but appear to constitute around 25% of adult cases. Due to their comorbidities and high mortality rate, these conditions pose a significant health risk. Although systemic and family therapy are considered among the most successful treatment modalities in adolescence, there is a need for expanded treatment options. With this background, the question arises as to what extent music therapy is already integrated into treatments. This review aims to include studies on music, music therapy, and eating disorders in general and covering all age groups. In all, 26 studies met the criteria for review, with a total of 1026 participants. None of the studies used music therapy combined with systemic or family-based therapy. However, despite differences between study designs, the individual studies show commonalities in their interventions and a relationship to the systemic and family-based approach. This review suggests that music therapy may be a valuable complement to the treatment modalities of systemic and family-based therapies as well as to constellations and sculpture approaches in eating disorders treatment. Further research is recommended to evaluate the effectiveness of such combined approaches. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions There is limited research on the effects of sociodemographic and socioeconomic factors on treatment outcomes in youth at clinical high risk for psychosis (CHRp). This study examined sociodemographic factors that may affect functional outcomes within this population. Specifically, we investigated the influence of race/ethnicity (dichotomized as non‐Hispanic whites [NHW] vs. people of colour [POC]), socioeconomic status (SES; operationalized as parental years of education), and their interaction on change in psychosocial functioning and symptoms over 6 months in a randomized trial of family‐focused therapy.CHRp youth (N = 128) participated in a randomized trial of family therapy (18 sessions of family therapy vs. 3 sessions of family psychoeducation). Sixty‐four participants who self‐identified as POC and 64 self‐identified NHW participants completed baseline and 6‐month follow‐up measures of positive and negative symptoms and psychosocial (global, role, and social) functioning. Multiple regression models were conducted to test the main effect of race/ethnicity on changes in positive and negative symptoms and functioning, and whether this effect was moderated by parental education.There was a significant interaction between race/ethnicity and parental education, such that higher parental education was associated with greater improvement in global functioning in NHW participants, but there was no relationship between parental education and global functioning in POC. Additionally, higher parental education was associated with a decrease in negative symptoms in NHW participants but not in POC. There were no significant effects of race/ethnicity or parental education on positive symptoms, nor on social or role functioning.Clinicians may consider tailoring psychosocial treatments according to the needs of diverse families who vary in sociodemographic factors such as educational attainment and race/ethnicity. [ABSTRACT FROM AUTHOR]

Attachment theory and the science of emotion provide a strong foundation for intervention at the family system level. Four therapeutic models in particular, Attachment‐Based Family Therapy, Emotion‐Focused Family Therapy, Dyadic Developmental Psychotherapy, and Emotionally Focused Family Therapy, demonstrate how a broad and accurate view of attachment relationships and emotion can be utilized to effectively intervene for a variety of presenting problems in a relational and empathic way for all involved. This paper continues a conversation that began at the Summit for Attachment and Emotion in Family Therapy in 2021 and aims to foster openness, collaboration, and affirmation between four different models of family therapy with shared theoretical roots. The presenters at the Summit and the authors of this paper view similarities across these models as validating and differences as opportunities to serve more families in unique ways, learning from one another's creativity to promote healing within families in the most effective and efficient ways possible. The paper frames the value of attachment theory and emotion science for family therapy, discusses the importance of learning from a variety of models with shared theoretical roots, presents brief summaries of the four models presented at the Summit, compares the models for similarities and complementarities, and shares highlights from each of the presenters from the Summit. [ABSTRACT FROM AUTHOR]

We write this paper as DClinPsy staff who have implemented Association of Family Therapy and Systemic Practice (AFT) Foundation and Intermediate level accreditation embedded within DClinPsy training. We describe the context and landscape in which this has happened, the positives we believe it brings and the challenges we have faced along the way. We offer suggestions for courses on this journey of approaches, methods and techniques that we have found helpful, and reflect on our next steps. Within the paper we include the voice of a trainee who is completing this training currently and consider what clinical psychologists in the NHS can do to support trainees and courses in achieving systemic secondary accreditation. [ABSTRACT FROM AUTHOR]

The writer shares the course of treatment with a gender nonbinary teenager and their parents that utilized techniques from drama therapy, relational self psychology, sculpting, and family therapy. Following the rupture and attempted repair with the patient's parents, work with the patient and their family finally led to a joint decision to terminate treatment. This case study discusses the clinical challenges and implications of working within a family system in which parents' values misalign with the psychotherapist's treatment goals. This paper contains misgendering that can emotionally trigger some individuals. [ABSTRACT FROM AUTHOR]

Family therapy is often indicated in the treatment of adolescents with mental health difficulties. The family context is often seen as a predisposing, precipitating, perpetuating, or a protective factor for a wide range of child and adolescent mental health concerns. Several approaches to family therapy are now recognized as evidence-based treatments for different psychiatric presentations. In this article, we hope to describe the relevance of family therapy for families with adolescents in India, present case illustrations on commonly used approaches to family therapy, and propose clinical practice guidelines. [ABSTRACT FROM AUTHOR]

Objectives: To assess the inclusion of Aboriginal and Torres Strait Islander parents in trials of parenting programs in Australia; the involvement of Indigenous fathers in such studies; and whether parenting programs are designed to be culturally appropriate for Aboriginal and Torres Strait Islander people. Study design: Scoping review of peer‐reviewed journal publications that report quantitative outcomes for Australian randomised control trials of parenting programs in which the participants were parents or caregivers of children under 18 years of age, and with at least one outcome related to children's health, health behaviour, or wellbeing. Data sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus databases. Data synthesis: Of 109 eligible publications, nine reported how many participants were Aboriginal or Torres Strait Islander people; three specified whether they were Aboriginal, Torres Strait Islander, or both. Two publications described specific interventions for Aboriginal and Torres Strait Islander children; both reported consultation with Indigenous people regarding program design. Of the 15 559 participating parents in all included publications, 93 were identified as Aboriginal or Torres Strait Islander people. No publications noted as study limitations the absence of consultation with Indigenous people or the low participation rate of Aboriginal and Torres Strait Islander families. Conclusions: The specific needs and interests of Aboriginal and Torres Strait Islander families have not generally been considered in Australian trials of parenting programs that aim to improve the mental and physical health of children. Further, Indigenous people are rarely involved in the planning and implementation of the interventions, few of which are designed to be culturally appropriate for Indigenous people. If parenting research in Australia is to support Aboriginal and Torres Strait Islander families, it must include consultation with local communities, adapt interventions and research methods to the needs of the participating parents and their communities, and improve the recruitment and retention of Aboriginal and Torres Strait Islander participants. [ABSTRACT FROM AUTHOR]

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ObjectiveFamily-based treatment (FBT) is a well-established intervention for adolescent anorexia nervosa (AN). Although FBT is efficacious in promoting weight gain and improvements in psychological symptoms, for some adolescents, cognitive/attitudinal recovery lags behind weight gain. This study conducted an exploratory post hoc analysis of outcomes of adolescents who achieved weight gain by the end of FBT but continued to experience elevated psychological symptoms post-treatment.MethodsData were drawn from two randomised controlled trials (RCTs) testing two forms of FBT (conjoint/whole family and parent-focussed). Descriptive statistics and generalised estimating equations were used to examine differences in treatment outcomes between non-cognitive responders (NCRs) (those who regained weight but continued to experience psychological symptoms) and full responders (FRs) (those who achieved both weight and cognitive restoration by the end of treatment) (n = 80; 83.7% female, Agemean [SD] = 14.66 [1.73]).ResultsBy 12 months post-treatment, there were no differences in weight between NCRs and FRs. However, NCRs had a slower trajectory of weight gain than FRs and continued to have elevated levels of psychological symptoms throughout the follow-up period.ConclusionsA subset of adolescents appear to continue to experience clinically significant levels of eating pathology up to 12 months after FBT even when weight restoration is achieved.

Neurodevelopmental disorders affect the lifespan of diagnosed individuals and their families. COVID-19 challenged these families with daily routine unpredictability requiring rapid adaptations. Moreover, associations and schools were closed, leaving these families without regular social support. Here, we investigate which individual and family factors can predict the caregiver’s depressive state and overall burden. An online study took place between 2021 and 2022. A total of 32 caregivers (30 women; 48 ± 8.22 years old; range 26 to 63 years old) reported having a family member with a neurodevelopmental disorder, the majority diagnosed with autism spectrum disorder. Caregivers responded to a protocol to assess the burden, resilience, depressive, anxious, and stress symptomatology, as well as the behavior of the diagnosed individual. Hierarchical multiple regressions were performed to identify protective and risk factors for the caregivers’ well-being. Caregivers’ depressive state was explained by 29.3% of the variance of the family cohesion factor, indicating that high levels of balanced family cohesion represent a crucial protective factor for reducing the caregiver’s depressive state. Additionally, overall caregiver burden was explained by 17.8% of the variance due to self-perception and 26.4% due to family cohesion, with the caregiver’s self-perception playing an important protective role in the overall perception of burden. The proportion of male and female respondents seems to corroborate the significant role of women in caregiving. These results emphasize the importance of considering both individual and family factors of caregivers during interventions, which have implications for family therapy with families of members diagnosed with neurodevelopmental disorders, specifically with autism.

ObjectiveMisconceptions around which patients will and will not benefit from family-based treatment (FBT) for adolescent eating disorders (EDs) limit referrals and access to this treatment modality. The present study explored whether common demographic and clinical factors that may prevent referral to FBT predict treatment outcomes in adolescent anorexia nervosa (AN) and bulimia nervosa (BN).MethodThe following predictors of treatment outcomes were assessed: baseline family and diagnostic factors (socioeconomic status, comorbidity, illness duration, parent feelings of self-efficacy, family status, prior treatment, sex and prior hospitalizations) in a combined sample of adolescents receiving FBT compared to those randomized to other treatment conditions, across six clinical trials in the United States and Canada (total n = 724, ages 12-18, 90% female across both diagnoses). AN and BN samples were examined separately.ResultsAny prior ED treatment emerged as the only predictor of outcome in AN and BN, such that having no prior treatment predicted better outcomes in FBT for AN, and in both FBT and other treatment modalities for BN. No other sociodemographic or clinical variables predicted outcomes for AN or BN in FBT or in other evidence-based treatment modalities.ConclusionsThe findings of this exploratory analysis suggest that commonly assumed factors do not predict outcome in FBT. Specifically socioeconomic and demographic factors or clinical variability in families seeking treatment do not predict treatment outcomes in FBT, or other evidence-based treatment modalities, with the exception of prior treatment. Providers should consider referring to FBT even when these factors are present.Public significanceThis manuscript reports that commonly assumed family, sociodemographic and diagnostic factors do not predict outcome in FBT or other evidence-based treatment modalities, with the exception of prior treatment. This data may be helpful for providers when considering referrals to FBT in the context of variability in these variables.

BACKGROUND: Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa (AN). Yet, remission is not achieved for about half of adolescents with AN receiving FBT. Understanding patient- and parent-level factors that predict FBT response may inform treatment development and improve outcomes. METHODS: Network analysis was used to identify the most central symptoms of AN in adolescents who completed the Eating Disorder Examination (EDE) prior to FBT (N = 409). Bridge pathways between adolescent AN and parental self-efficacy in facilitating their childs recovery from AN were identified in a subset of participants (n = 184). Central and bridge symptoms were tested as predictors of early response (⩾2.4 kg weight gain by the fourth session of FBT) and end-of-treatment weight restoration [⩾95% expected body weight (EBW)] and full remission (⩾95% EBW and EDE score within 1 standard deviation of norms). RESULTS: The most central symptoms of adolescent AN included desiring weight loss, dietary restraint, and feeling fat. These symptoms predicted early response, but not end-of-treatment outcomes. Bridge symptoms were parental beliefs about their responsibility to renourish their child, adolescent discomfort eating in front of others, and adolescent dietary restraint. Bridge symptoms predicted end-of-treatment weight restoration, but not early response nor full remission. CONCLUSIONS: Findings highlight the prognostic utility of core symptoms of adolescent AN. Parent beliefs about their responsibility to renourish their child may maintain associations between parental self-efficacy and AN psychopathology. These findings could inform strategies to adapt FBT and improve outcomes.

BACKGROUND: The impairing neurodevelopmental course of bipolar disorder (BD) suggests the importance of early intervention for youth in the beginning phases of the illness. OBJECTIVE: We report the results of a 3-site randomized trial of family-focused therapy for youth at high-risk (FFT-HR) for BD, and explore psychosocial and neuroimaging variables as mediators of treatment effects. METHODS: High-risk youth (

PurposeCaregivers play a pivotal role in the success of family-based treatment (FBT) for anorexia nervosa (AN). Caregiver burden is frequently demonstrated in eating disorders (EDs) and may impact FBT outcomes. This study examined factors associated with caregiver burden before starting FBT and whether pre-treatment caregiver burden was associated with weight gain during FBT.MethodsParticipants included 114 adolescents with AN or atypical AN (mean age = 15.6 years, SD = 1.4) and a primary caregiver (87.6% mothers) who received FBT in the United States. Before starting treatment, participants completed self-report measures of caregiver burden (via the Eating Disorder Symptom Impact Scale), caregiver anxiety, caregiver depression, and ED symptoms. Clinical characteristics and percentage of target goal weight (%TGW) at FBT session 1 and 3 and 6 months after starting treatment were obtained via retrospective chart review. Hierarchical regressions examined predictors of caregiver burden before FBT initiation. Associations between pre-treatment caregiver burden and %TGW gain at 3 and 6 months after starting FBT were assessed with hierarchical regressions.ResultsCaregiver anxiety (p

Abstract Introduction ‘Let’s Talk About Children’ is a brief family focused intervention developed to improve mental health outcomes of children of parents with mental illness (COPMI). This study aims to assess the efficacy of LTC in improving mental health of children of parents with schizophrenia or bipolar disorder in China. Methods The planned study is a multicentre parallel group randomized wait-list controlled trial. A total of 400 eligible families with children aged 8 to 18 years will be recruited, 200 each for families with parental schizophrenia or bipolar disorder. The intervention group will receive Let’s Talk About Children delivered by a trained therapist, while the control group will receive treatment as usual. The primary outcomes are child mental health measured by the strengths and difficulties questionnaire and parent–child communication measured using the parent-adolescent communication scale. Parental mental health and family functioning are secondary outcomes. This study also plans to explore mediating factors for the effect of Let’s Talk About Children on child mental health, as well as conduct a cost-effectiveness analysis on using Let’s Talk About Children in China. Conclusion The present study will provide evidence for the efficacy of Let’s Talk About Children in families with parental schizophrenia and bipolar disorder in China. In addition, it will evaluate potential mechanisms of action and cost-effectiveness of Let’s Talk About Children, providing a basis for future implementation. Trial registration ChiCTR2300073904.

Abstract Background Family therapy for anorexia nervosa (FT-AN) is the first line recommended treatment for child and adolescent anorexia nervosa. Despite evidence of its efficacy, little is understood about the treatment mechanisms. This study aimed to understand how young people who have received FT-AN perceive change to occur across treatment. Method Fifteen adolescents (age 12–18 years) completed individual semi-structured interviews online. Recordings were transcribed verbatim and analysed using reflexive thematic analysis. Results Four inter-connected themes describing the process of change during treatment were generated; (1) relationships as the vehicle for change, (2) an awakening, (3) through, not around – no way out, (4) the life beyond. Conclusions Current data match relatively closely with theoretical models of FT-AN and emphasise the importance of building trust with all family members, including the young person. Additionally, supporting the family to create a trusting context in which there is a sense that the only way out of the illness is by going through it (rather than avoiding it) is critical. Empirical investigation of each of the described mechanisms is needed.

To increase cultural relevance and maximize access for historically underserved populations, there is a need to explore mechanisms underlying treatment outcomes during piloting. We developed a mixed-method approach, Integrated Clinical and Implementation Mapping (ICIM), to explore clinical and implementation mechanisms to inform improvements in content and delivery. We applied ICIM in a pilot of Tuko Pamoja, a lay counselor-delivered family intervention in Kenya (10 families with adolescents ages 12-17). ICIM is a 3-phase process to triangulate data sources to analyze how and why change occurs within individual cases and across cases. We synthesized data from session and supervision transcripts, fidelity and clinical skills ratings, surveys, and interviews. Outputs included a comprehensive narrative and visual map depicting how content and implementation factors influenced change. For Tuko Pamoja, ICIM results showed common presenting problems, including financial strain and caregivers distress, triggering negative interactions and adolescent distress. ICIM demonstrated that active treatment ingredients included communication skills and facilitated, prescribed time together. Families improved communication, empathy, and hope, facilitated improved family functioning and mental health. Key implementation mechanisms included provider clinical competencies, alliance-building, treatment-aligned adaptations, and consistent attendance. Results guided manual and training refinements and generated hypotheses about mechanisms to test in larger trials.

OBJECTIVE: Although family-based treatment (FBT) is considered a first-line treatment for adolescent anorexia nervosa (AN), it is underutilized in community settings and is unavailable to many families for a multitude of practical reasons (e.g., costs of treatment, transportation constraints). Adapting FBT interventions for delivery in home-based and community-based settings may reduce pragmatic barriers to treatment uptake and engagement. METHODS: This pilot effectiveness-implementation trial will assess outcomes, implementation, and mechanisms of FBT adapted for the home setting (FBT-HB), delivered in the context of community-based behavioral health agencies. Adolescents with AN-spectrum disorders (n = 50) and their caregivers will be randomly assigned to either FBT-HB or home-based treatment as usual (TAU; integrated family therapy approach). Caregivers and adolescents will provide data on weight, eating, and putative treatment mechanisms, including caregiver self-efficacy and adolescent eating-related and weight-related distress. Implementation constructs of feasibility, acceptability, and appropriateness will be measured among providers and participating families. HYPOTHESES: We expect that FBT-HB will be feasible, acceptable, and appropriate, and will outperform TAU in terms of improvements in adolescent weight and eating-related psychopathology. We further expect that caregiver self-efficacy and adolescent eating-related and weight-related distress, but not general distress, will show greater improvements in FBT-HB relative to TAU and will be associated with better adolescent weight and eating outcomes in FBT-HB. POTENTIAL IMPLICATIONS: The proposed study has clear potential to advance scientific and clinical understanding of the real-world effectiveness of FBT for AN, including whether adapting it for the home setting improves its accessibility and effects on treatment outcome.

ObjectiveVarious approaches exist to treat youth with anorexia nervosa (AN). Family-based treatment (FBT) has never been compared to long inpatient, multimodal treatment (IMT) in a randomized controlled trial (RCT). The aim of this study was to compare data on body weight trajectories, change in eating disorder psychopathology, hospital days and treatment costs in RCTs delivering FBT or IMT.MethodReview of RCTs published between 2010 and 2020 in youth with AN, delivering FBT or IMT.ResultsFour RCTs delivering FBT (United States, n = 2; Australia, n = 2), one RCT delivering Family Therapy for AN (United Kingdom) and two RCTs delivering IMT (France, n = 1; Germany, n = 1) were identified from previous meta-analyses. The comparison of studies was limited by (1) significant differences in patient baseline characteristics including pretreated versus non-pretreated patients, (2) use of different psychometric and weight measures and (3) different initial velocity of weight recovery. Minimal baseline and outcome reporting standards for body weight metrics and nature/dose of interventions allowing international comparison are needed and suggestions to developing these standards are presented.DiscussionAn RCT should investigate, whether FBT is a viable alternative to IMT, leading to comparable weight and psychopathology improvement with less inpatient time and costs.