Family assessment and therapy in CAP — indication matching and safe practice (MEQ)

(i) Assessment. Safety first every time (abuse/neglect, IPV, suicide, medical risk). Confidentiality contract with adolescents. 3-generation genogram; structural map (hierarchy, boundaries, triangulation); circular questions for sequences without linear blame; multi-informant diagnosis of the index child; EE proxies and warmth; accommodation screen when OCD/anxiety present; carer mental health and school collateral. Family work never replaces diagnosis or safeguarding.[6][7]

(ii) Matching — diagnosis-matched packages (not one generic family chat):

• A (adolescent AN): FBT — parents lead refeeding (phase 1), then return of control, then adolescent issues; superior full-remission outcomes vs adolescent-focused individual therapy in landmark RCT; concurrent medical monitoring.[1]
• B (preschool ODD): PCIT (or intensive behavioural parent training) — CDI then PDI with live coaching; meta-analytic support for reducing externalising behaviour; target coercive cycles.[2]
• C (depression + SI + cut-off): ABFT — relational reframe, alliance building, attachment tasks, autonomy promotion; RCT support for reducing suicidal ideation and depressive symptoms vs enhanced usual care, plus individual risk plan.[3]

(iii) Safety limits. Do not run conjoint communication sessions with active IPV/coercive control or when free speech is unsafe — separate, protect, report under local law. Acute medical or suicide risk: stabilise the child first. Statutes are jurisdiction-specific.[4]

(iv) Holding therapy. Explicitly refuse coercive holding/rebirthing/forced-regression therapies as unproven and potentially dangerous (APSAC). Offer non-coercive caregiving support and evidence-based alternatives; no medication creates attachment.[4]

(v) Fidelity/prognosis. Real-world benefit of packages such as functional FFT depends on therapist adherence; manualised delivery, homework, and multiagency intensity improve outcomes versus unstructured chats. Systemic therapy has broader RCT support but viva answers still match named packages to indications.[5][6]