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 Family therapy can be utilized for an array of purposes to benefit the patient by addressing factors in their environment. As noted by Wheeler (2014), families can be given psychoeducation, provided supportive therapy, while in some cases, the family structure and possible dysfunction patterns can be evaluated to determine their significance in the presented concern. The PMHNP should evaluate the patient’s needs when determining the therapy (Wheeler, 2014). Cognitive-behavioral therapy (CBT) is an empirically supported treatment for the individual that can be integrated into the family approach to benefit the patient’s negative beliefs and behavioral patterns (Wheeler, 2014). 

CBT: Comparison of Family and Individual Therapy

            CBT is an efficient and practical approach to treating post-traumatic stress disorder, obsessive-compulsive disorder, and anxiety (Kaczkurkin and Foa, 2015). This short-term goal-oriented method targets maladaptive patterns contributing to dysfunctional emotional or behavioral state (Kaczkurkin and Foa, 2015). In CBT, the PMHNP addresses the patient’s negative cognitions or behaviors that are currently supplying the patient with a continued negative state (Kaczkurkin and Foa, 2015). There can be a primary concern of the unit in a family session, such as a child’s behavior. The PMHNP utilizing CBT will address the family relational patterns and practices that allow the behavior to continue (Nichols, 2014). In educating and acknowledging these behaviors, the PMHNP can help address any misconceptions or negative perceptions of the identified patient while also collaboratively with the family reinforcing positive patterns (Nichols, 2014). 

            While shadowing therapists who have utilized CBT, many patients with distorted perception would have benefited from an integrated family approach. In the case of a 15 y/o patient with a history of major depression, several symptoms, such as worthlessness and sadness, were often reinforced by her parental figures’ behavior. The patient, who had established a healthy rapport with the PMHNP, was the youngest of four children sent to live with her grandmother due to aggression at home that had led to a divorce. Although the patient’s negative distortions were often challenged, such as “no one caring,” she often felt defeated and rejected due to her parents not answering her phone calls. The participation of all members within the patient’s family is required for education to be provided concerning the behaviors attributed to the patient’s emotional disturbance (Nichols, 2014). 

Obstacles in the Family Setting

           As indicated in Nichols (2014), the PMHNP may face barriers when addressing the identified patient’s cognitive distortions in the family setting. As shown in Laureate Education (2013) media, several female individuals participating in the session identified their families as unsupportive in their sexual assault. Survivors of sexual assault can often develop post-traumatic stress disorder (PTSD), depression, along with other challenges if treatment is not sought (Cohen, Mannarino & Kinnish, 2017). The individual, along with those in their support system such as their family, requires education on the multiple issues and challenges they face due to the trauma (Cohen et al., 2017). 

           As a result, the PMHNP must assess and treat the family structure to determine which behavioral and communicational patterns can be exacerbating or contributing to the identified patient’s negative distortions (Nichols, 2014). Patterson (2014) notes the collaboration of CBT and the system theory to identify dysfunction structure and organization in the patient’s family unit. For example, the female patient is in the media expressed negative emotional patterns that continued to be reinforced by their families unsupportive and, at times, accusatory tone (Laureate Education, 2013). The PMHNP believing in models of circular causality and contextuality would benefit in assisting the patient if assessing the family’s structure, communication, and behavioral patterns to determine which negative actions need to be decreasing to allow her to recovery along with returning to a phase of homeostasis (Patterson, 2014). However, including the family as a whole unit within the treatment so that those patterns can be reinforced or negated would increase the client’s positive mental health outcome. Often choosing the “healthier” patient within the family structure to recognize dysfunctional patterns within the system is beneficial (Wheeler, 2014). 

References

Cohen, J. A., Mannarino, A. P., & Kinnish, K. (2017). Trauma-Focused Cognitive Behavioral Therapy for Commercially Sexually Exploited Youth. Journal of Child & Adolescent Trauma, 10(2), 175–185. doi:10.1007/s40653-015-0073-9

Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-Behavioral Therapy for Anxiety Disorders: An Update on the Empirical Evidence. Dialogues in Clinical Neuroscience, 17(3), 337– 346. Laureate Education (Producer). (2013). Johnson Family Session 3 [Video file]. Author: Baltimore, MD.

Nichols, M. (2014). The Essentials of Family Therapy (6th ed.). Boston, MA:

Pearson. Patterson, T. (2014). A Cognitive-Behavioral Systems Approach to Family Therapy. Journal of Family Psychotherapy, 25(2), 132-144

Wheeler, K. (Ed.). (2014). Psychotherapy for the Advanced Practice Psychiatric Nurse: A How-to Guide for Evidence-Based Practice. New York, NY: Springer.

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