FAMILY THERAPYIntroduction:

Family therapy is the branch of psychiatry which sees an individual’s psychiatric symptoms as inseparably related to the family in which he lives. Thus the focus of treatment is not on the individual, but the family.

Family therapy is a relatively new development that came about in the mid-twentieth century as an adjunct to individual treatment and refers to the treatment of the family as whole.

Family therapists use a wide variety of theoretical philosophies and techniques to bring about change in dysfunctional patterns of behaviour and interaction, some therapists may focus on the here and now,

Several or sometimes all members of a family members take part in this treatment. Usually both parents are involved, often together with a child, grandparents, or others members of the extended family

Although different therapists may adhere to different theories and use a wide variety of methods, the goals of family therapy are basically the same. These goals include the following

To reduce dysfunctional behaviour of individual family members. To resolve or reduce intrafamily relationship conflicts. To improve family communication skills. To heighten awareness and sensitivity to other family members to meet their needs. To strengthen the family ability to cope with the major life stressors and traumatic events. To improve integration of the family system into the social system. To improve autonomy for each member.reduce distress in the member who is patient.

Indication and contraindication of family therapyIndications:

1. Problems in the relationship within the family(erg existence of communication or generation gap)

2. Interdependence of symptoms(e.g. the wife’s depression being contingent on the husband’s alcohol consumption and vice versa)

3. Failure of individual therapy(may be because family tensions have not been handled)4. Development of stress in other family members when one family member improves (e.g.

development of depression in wife following husband’s giving up drinking, leading to his improves participation in family matters)

Contraindications:

A. Family factors

1. Family in the process of breaking up2. Families in which tense, dysfunctional equilibrium is present.3. Families staying apart4. No availability of the key family member5. Unwillingness to accept the therapy.

Functions of the family therapy

1. Boundary function : boundaries will maintain a distinction between individuals with the family. Rigid boundaries prevent family members from trying out new ideas.

2. Communication function : communication within the family encourages its members to express their feelings or emotions appropriately.

3. Supportive function : supportive function within the family give freedom to grow and explore new roles within the family members.

4. Socialization function : socialization helps to interact, negotiate and plan adopts coping skills within the members of the family.

5. Biological function : family is a medium where the sex relations are regulated.6. Psychological function : love, belongingness, affection, sympathy, security,

attention, emotional satisfaction, sexual relationship, intimacy etc. will be attained through family.

7. Educational function : mother is the first teacher and primary care giver who will take care of the children. Child’s personality and character formation will be attained through family.

8. Protective function: family protects the interest of the child, provides security to cultivate healthy behavior.

9. Recreational function: family creates an atmosphere where the child’s interest can be fulfilled. The love among family members will create positive interest in the child.

10. Religious function : family develops religious thoughts, kind heartedness and fellow belonging. The child learns more moral values, ethics, codes, honesty, truthfulness, traditions and religious patterns.

11. Cultural function : family molds its members according to its culture. It transmits ideas, folkways, mores, customs, traditions, beliefs and values from one generation to another generation.

12. Social function :

-maintain social status and controls member’s activities.

-Promotes safety and security and lays emphasis on kinship patterns -provides physical shelter, food, clothing which are necessary to the existence of life.

TYPES OF FAMILY THERAPY:

INDIVIDUAL FAMILY THERAPY

In individual family therapy, each family member has a single therapist. The whole family may meet occasionally with one or two of the therapists to see how the member’s ae relating to one another and work out specific issues that have been defined by the individual members.

CONJOINT FAMILY THERAPY

The most common type of family therapy is the single-family group, or conjoint family therapy. The nuclear family is seen, and the issues and problems raised by the family are the ones addressed by the therapist. The way in which the family interacts is observed and becomes the focus of therapy. The therapist helps the family deal more effectively with problems as they arise and are defined.

COUPLES THERAPY

Couples are often seen by the therapist together. The couple may be experiencing difficulties in their marriage, and in therapy, they are helped to work together to seek a resolution for their problems. Family patterns, interaction and the communication styles, and each partner’s goals, hopes and expectations are examined in therapy. This examination enables the couple to find a common ground for resolving conflicts by recognizing and respecting each other’s similarities and differences.

MULTIPLE FAMILY GROUP THERAPY

In multiple family group therapy, four or five families meet weekly to confront and deal with the problems or issues they have in common. Ability or inability to function well in the home and community fearing of talking to or relating to others, abuse, anger, neglect, the development of social skills, and responsibility for oneself are some of the issues on which these group focus. The multiple family group become the support for all the families. The network also encourages each person to reach out form new relationships outside the group.

MULTIPLE IMPACT THERAPY

In multiple impact therapy, several therapists come together with families in a community setting. They live together and deal with pertinent issues for each family member within the context of the group. Multiple impact therapy is similar to multiple family group therapy except that it is more intense and time limited. Like multiple family group therapy, it focuses on developing skills or working together as a family and with other families.

NETWORK THERAPY

Network therapy is conducted in people’s homes. All individuals interested or invested in a problem or crisis that particular person or persons in a family are experiencing take part. This gathering includes family, friends, neighbours, professional groups or persons, and anyone in the community who has an investment in the outcome of the current crisis. People who form the network generally know each other and interact on a regular basis in each other’s lives. Thus a network may include as many as 40 to 60 people.

Family therapy assessmentBoyer and Jeffrey (1984) describe six elements on which families are assessed to be either functional or dysfunctional. The six element of assessment include:

Communication Self-concept reinforcement Family member expectations. Handling differences. Family interactional patterns. Family climate

The six elements of assessment are described below:

Communication

Functional communication patterns are those in which verbal and non-verbal messages are clear, direct, and congruent between sender and intended receiver. Family member are encouraged to express honest feelings and opinions, and all members participate in decisions that affect the family system. Each member is an active listener to other members of the family.

Making assumption: in this, one assumes that others will know what is meant by an action or an expression

For e.g., a father says to his teenage son “you should have gone to market to bring some provisions for home during my absence at home”.

Belittling feelings: this behaviour involves ignoring or minimizing another’s feelings, when they are expressed. This encourage the individual to withhold honest feelings to avoid being hurt by the negative response.

For e.g. elder brother scolding his sister (young one) and she is angry with him. Then the mother consoles girl that “oh don’t be angry, he does not mean anything”.

Failing to listen: in this, one does not hear what the other individual is saying. This can mean , not hearing the words by ‘turning out’ what is being said, or It can be selective listening, in which a person hears only selective part of the message or interprets in a selective manner.

Communicating indirectly: it usually means that an individual does not cannot present a message to receiver directly, so he or she seeks to communicate through a third person.

Presenting double-bind messages: in this, family-member may respond to a direct request by another family member only to be rebuked when the request is fulfilled.

Self-concept Reinforcement

Functional families strive to reinforce and strengthen each member’s self-concept, with the positive results being that family members feel loved and valued.in this, the manner in which children see and value themselves is influenced most significantly by the messages they receive concerning their value to other members of the family.

Family member’s expectations

Every individual have some expectations about the outcomes of the life situations they experience. The expectations are related to and significantly influenced by earlier life experiences. Each family member is different, with different strength’s and limitations. Each member must be valued independently.

Handling differences

It is difficult to conceive of two or more individuals living together who agree on everything all of the time. Serious problems in a family functioning appear when differences becomes equated with “badness” is seen not caring. Member are willing to hear the other person’s position, respect the other person’s right and work to modify the expectations on both sides of the issue to negotiate a workable solution.

Family interactional patterns

All families develop recurring, predictable patterns of interactions over time. These are often thought of as “family rules”. Interactions may have to do with communication expressing expectations and handling differences. Family rules are functional when they are workable and constructive and promote the needs of all family members.

Family climate

The atmosphere or climate of a family is composed of a blend of the feelings and experiences that are the result of the family member’s verbal and non-verbal sharing and interacting. It has been suggested that a positive family climate is founded on trust and is reflected in openness. A dysfunctional family climate is evidenced by tensions, pain, physical disabilities, frustrations or guilt

Music TherapyIntroduction:

Music therapy is a special type of therapy where forms of musical interactions and communication are used alongside verbal communication.

Systemic process of interventions wherein the therapist helps the client to promote health, using music experiences and the relationship developing through them

Therapies involving music therapy allow the child or adolescent to express her or himself in these disciplines and can be effective with those who have difficulty communicating with others.

History of music therapy:

Using music as a healing medium dates back to ancient times which is evident in biblical scriptures and historical writings of ancient civilizations such as Egypt, china, India, Greece, and Rome

The oldest known documentation of medical practices, the kahum papyrus, refers to the use of incantations for healing the sick.

Greek philosopher Pythagoras is considered the founder of music therapy in the 6th century

In 1800, Florence nightingale in France recognized the power of music in hospital wards during Crimean war and used to aid in healing process for soldiers.

ADVANTAGES OF MUSIC THERAPY

Music can help you to fight with stress find comfort, and manage pain. Women planning vaginal childbirth are usually encouraged to bring along music that

will help them to relax during their labour. It increases relaxation It reduces loneliness It enhances spiritual connection Helps in fight with depression and anxiety Facilitates emotional expressions Improves cognitive skills like learning, listening and attention span Social interaction is stimulated It improves communication and enhance memory.

Indications

Psychotic disorders

Schizophrenia Schizoaffective disorder Drug induced psychosis

Mood disorders

Major depressive disorder Bipolar disorder

Developmental disorders

Autism, mental retardation

Neurological disorders

Dementia, Parkinson’s disease

Types of music therapy

Background music therapy

It is a form of therapy in which music is heard for an average of 8 to 12 hours per day as part of a hospital routine.

It is transmitted via audio tapes and radio The aim of this therapy is to create a calm environment in the hospital.

Contemplative music therapy

It helps the patients to appreciate the significance of music and art in general Before music is played for patients, they are given a biography of the composer and

other details about the music. This can be administered in a group setting or individually.

Combined music therapy

It is used in conjunction with other therapeutic procedures. Unlike background music therapy, it call for the patient to select musical

compositions that enhance musical outcome and suit the patient. Sometimes in this form of musical therapy, hypnosis is conducted while the subject

listens to the music. This form of music therapy has been used in combination with cerebral electro sleep

therapy and behaviour therapy.

Executive music therapy

It consists of individual or group singing and playing musical instruments. Patients with long hospital stays are the best candidates for this form of therapy.

Executive Iatromusic therapy

In this therapy a musician performs in children’s psychiatric units. This form of therapy frequently is used in managing emotionally disturbed, mentally

retarded and dyslexic children.

Creative music therapy

In this a patient write a song, compose music, and play instruments as a form of catharsis.

In this repressed feelings or fears to be expressed in music and song.

Role of nurse in music therapy:

The nurse should provide music therapy according to the age of person according to their interests like and dislikes

The nurse should provide music therapy to the client suffering from schizophrenia to diminish the visual perceptual abnormalities and divert the mind of the client

The psychiatric nurse should provide music therapy to the client who is suffering from drug induced psychosis for diversional purpose.

Nurses can provide music therapy to the client who is suffering from autism to increase their activity with the flow of the music

Michael gelder, paul Harrison, Philip cowen Shorter oxford textbook of psychiatric Fifth edition

Louise rebraca shives basic coccepts of psychiatric-mental health nursing Wolters Kluwer publications Eighth edition

BT Basavanthappa’s “textbook of essentials of mental health nursing”

Jaypee Publications,

Page No, 224, 225,226,227,228,229,230

R Sreevani's “textbook of a guide to mental health & psychiatric nursing”

Jaypee Publications,

Page No, 147,148,153

https://en.wikipedia.org/wiki/Music_therapy

https://en.wikipedia.org/wiki/Family_therapy

http://www.turkpsikiyatri.org/arsiv/music_therapy_psychiatry

Bibliography:

Michael gelder, paul Harrison, Philip cowenShorter oxford textbook of psychiatric

Fifth edition

Louise rebraca shives basic coccepts of psychiatric-mental health nursingWolters Kluwer publicationsEighth edition

BT Basavanthappa’s “textbook of essentials of mental health nursing”

Jaypee Publications,

Page No, 224, 225,226,227,228,229,230

R Sreevani's “textbook of a guide to mental health & psychiatric nursing”

Jaypee Publications,

Page No, 147,148,153

https://en.wikipedia.org/wiki/Music_therapy

https://en.wikipedia.org/wiki/Family_therapy

http://www.turkpsikiyatri.org/arsiv/music_therapy_psychiatry