Program

Mar 19, 2013

OVERVIEW

Integrative family therapy is a clinic-based, family-focused therapy that focuses on identifying and modifying problematic family communication patterns.  The approach is designed for families of males between the ages of 14 and 16 who exhibit consistent bullying behavior.  It targets adolescent anger, risky behaviors, problematic personality characteristics, and health-related quality of life.  Adolescents in the program report reduced outward expressions of anger and improved their ability to control anger.  In addition, these boys reported decreased risky behaviors, improved interpersonal behavior (e.g., emotional distance, social withdrawal), and improved mental health.  Most impacts remained after 12 months.

DESCRIPTION OF PROGRAM


Target Population:
Families of 14-16 year-old boys exhibiting consistent bullying behavior

This family-focused therapeutic approach consists of weekly (first 2 months) and bi-weekly (final 4 months) 90-minute sessions over 6 months.  Two therapists work with each family to improve adolescents’ ability to cope with anger, to avoid risky behaviors, and to address problematic social traits.  In addition, therapy seeks to improve adolescents’ perceptions of their own well-being.  The therapists use techniques from psychodynamic, behavioral, systematic, gestalt, and psychodrama therapies to help families identify and alter communication patterns that foster negative adolescent outcomes.

EVALUATION OF PROGRAM

Nickel, M.K., Krawczyk, J., Nickel, C., Forthuber, P., Kettler, C., Leiberich, P., Muehlbacher, M., Tritt, K., Mitterlehner, F.O., Lahmann, C., Rother, W.K., & Loew, T.H. (2005). Anger, interpersonal relationships, and health-related quality of life in bullying boys who are treated with outpatient family therapy: A randomized, prospective, controlled trial with 1 year of follow-up, Pediatrics, 116(2), 247-54.

Evaluated Population:  A total of 44 (22 intervention, 22 control) German boys, ages 14-16, were evaluated in this efficacy study.  Participants were from a rural town in Germany, and about 70 percent of the sample reportedly lived with both parents.  Roughly 25 percent of families’ principal wage earners were unemployed at baseline.  About two-thirds of the boys met criteria for more than one DSM-IV mental health disorder.

Approach:  Using a random numbers table in Excel, researchers identified 320 families within a 20-km radius of the clinic providing the intervention.  Trained staff reached 302 families via telephone and screened any adolescent males based on age, bullying behaviors, psychotic illness, pending criminal charges, use of psychotropic medication and/or psychotherapy, and current use of narcotics.  Forty-four boys meeting inclusion criteria were randomized to treatment or control group by clinic administrators using Excel random numbers tables.  Groups were equivalent at baseline.

The treatment group participated in 6 months of integrated family therapy.  During the same time period, the control group received a placebo intervention consisting of “a structured and detailed survey of the psychological state of health, daily routine, and events.”

Outcomes of interest included adolescents’ anger, risk behaviors, interpersonal relationships, and health-related quality of life.  Assessments for both groups were conducted by blinded staff every 2 weeks until the end of the intervention (6 months) and then again 12 months after the final therapy session.  All outcomes were assessed via face-to-face interviews, with the exception of risky behavior, which was apparently assessed using a self-administered questionnaire.

Results:  Overall, integrative family therapy had positive impacts on all outcomes of interest.

Bullying – The intervention resulted in statistically significant reductions in bullying behavior for boys in the treatment group, compared with boys in the control group, with decreases of 72 percent and nine percent, respectively.  This impact remained significant after one year.

Anger – Boys in the intervention group reported improvements in their experience of anger and their ability to cope with anger, compared with their peers in the control group.  Specifically, significant impacts were found on four out of five measures of anger.  Intervention group boys reported a lower current state of anger, reduced tendencies to react with anger and to direct anger outward, and an increased tendency to keep anger under control.  However, boys in the intervention group were no less likely to suppress anger than those in the control group.    These impacts were significant and non-significant, respectively, at both post-intervention and 12-month follow-up.

Risky behavior – Seven risk behaviors were assessed in this evaluation.  Boys in the intervention reported significant improvements across these seven domains, compared with the control group.  At the post-intervention assessment, intervention group boys reported significantly less drug use, smoking, binge drinking, excessive media use, sex without a condom, sex while using drugs and alcohol, and sexual disinhibition than their peers in the control group.  The intervention group was found to have reduced scores on the 28-point risk behavior index by an average of 6.3 points more than the control group.  However, these impacts were no longer significant at the 12-month follow-up for drug use, smoking, or sex while using drugs and alcohol.

Interpersonal relationships – The intervention had significant positive impacts on six out of eight interpersonal traits at the post-intervention assessment.  Impacts on five out of eight traits remained significant at the 12-month follow-up.  Specifically, boys in the intervention group exhibited reduced dominance, competitiveness, emotional distance, social withdrawal, impressionability (post-intervention only), and pushiness compared with boys in the control group.  No significant differences related to submissiveness or being overly accommodating were noted between groups.

Well-being – Results indicated significant positive impacts at the post-intervention and 12-month follow-up on five out of eight measures of adolescent well-being.  Boys in the intervention group reported improved general, emotional, and mental health, vitality, and social functioning, compared with boys in the control group.  Groups did not differ at any time point in terms of physical functioning, physical disability, or pain symptoms.

SOURCES FOR MORE INFORMATION

References

Nickel, M.K., Krawczyk, J., Nickel, C., Forthuber, P., Kettler, C., Leiberich, P., Muehlbacher, M., Tritt, K., Mitterlehner, F.O., Lahmann, C., Rother, W.K., & Loew, T.H. (2005). Anger, interpersonal relationships, and health-related quality of life in bullying boys who are treated with outpatient family therapy: A randomized, prospective, controlled trial with 1 year of follow-up, Pediatrics, 116(2), 247-54.

Contact Information

Marius K. Nickel, MD

Inntalklinik

84359 Simbach am Inn, Germany

KEYWORDS:  Adolescents (12-17), Male Only, White/Caucasian, Rural, Clinic/Provider-Based, Counseling/Therapy, Parent or Family Component, Family Therapy, Conduct/Disruptive Disorders, Anxiety Disorders/Symptoms, Health Status/Conditions, Other Social/Emotional Health, Condom Use and Contraception, Other Reproductive Health, Aggression, Bullying

Program information last updated on 3/19/13.