Psych MEQs / SAQs · Child and adolescent psychiatry — family assessment and therapy
Family assessment and therapy in CAP — indication matching and safe practice (MEQ)
FRANZCP-style MEQ on CAP family assessment, FBT/PCIT/ABFT matching, safety limits, refusal of coercive therapies, and fidelity.
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(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]
References7ShowHide
- [1]Lock J, Le Grange D, Agras WS, et al. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa Arch Gen Psychiatry, 2010.PMID 20921118
- [2]Thomas R, Abell B, Webb HJ, et al. Parent-Child Interaction Therapy: A Meta-analysis Pediatrics, 2017.PMID 28860132
- [3]Diamond GS, Wintersteen MB, Brown GK, et al. Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial J Am Acad Child Adolesc Psychiatry, 2010.PMID 20215934
- [4]Chaffin M, Hanson R, Saunders BE, et al. Report of the APSAC task force on attachment therapy, reactive attachment disorder, and attachment problems Child Maltreat, 2006.PMID 16382093
- [5]Sexton T, Turner CW The effectiveness of functional family therapy for youth with behavioral problems in a community practice setting J Fam Psychol, 2010.PMID 20545407
- [6]Retzlaff R, von Sydow K, Beher S, et al. The efficacy of systemic therapy for internalizing and other disorders of childhood and adolescence: a systematic review of 38 randomized trials Fam Process, 2013.PMID 24329407
- [7]Calvocoressi L, Lewis B, Harris M, et al. Family accommodation in obsessive-compulsive disorder Am J Psychiatry, 1995.PMID 7864273