Family Psychotherapy

Family therapy has been described for situations in which family relationships are conflictual, the ill child or a sibling is exhibiting poor emotional or behavioral adaptation, or the family is having significant difficulty setting limits that ensure effective illness care or satisfactory developmental outcomes for the ill child or siblings. Methods of family therapy to address poor parenting, poor parental collab

Table 29-6. Indications for referral for family therapy

Marked family distress

Poor collaboration and communication with the medical team Disabling emotional and/or behavioral symptoms in the ill child and/or siblings Marked marital stress involving the ill child and/or siblings Problems ensuring that the ill child adheres to the treatment regimen Exhaustion, anxiety, burnout, and/or depression in one or both parents oration, and poor parent-child relationships have also been described.

Family therapy has been used in the treatment of behavior and relationship concerns in pediatric physical illness and pediatric psychosomatic disorders for the past 30 years (Minuchin et al. 1978; Sargent 1983). There are a variety of family therapy techniques such as structural family therapy (Minuchin 1974; Minuchin et al. 1978), narrative therapy (White 2007; White and Epston 1990), and collaborative therapy (Madsen 2003) that may hold promise with these families. However, although benefits in terms of improved physical symptoms, family function, and child psychosocial outcomes have been well described (Gustafsson et al. 1986; McDaniel et al. 1992; Ryden et al. 1994; Sargent 1997; Weihs et al. 2002), there are no randomized clinical trials of family therapy for children with chronic pediatric physical illnesses. Although there are clear clinical indications for referral for family therapy (see Table 29-6), trials of family therapy for this population are urgently needed.

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