The limitation of a patient-centered approach to the treatment of obsessive-compulsive disorders are underlined by the failure of modern behaviour therapy techniques to help usefully more than 50 per cent of patients. The concept of family homeostasis is discussed in relation to two cases of obsessive-compulsive neurosis which failed to respond to patient-centred treatment over several years. The successful treatment of these cases in a family context is described. It is suggested that the comparative success of behaviour therapy in treating obsessive-compulsive disorders, which were previously regarded as generally intractable, has encouraged the premature use of patient-orientated behavioural techniques in cases where family therapy may be more appropriate. Although there is evidence that helping the families of obsessive-compulsive patients to verbalise feelings facilitates symptomatic improvement, the precise mechanisms whereby improvement occurs require further elucidation.
The methods used by the Rehabilitation Unit of the Repatriation General Hospital, Daw Park, to involve relatives of stroke patients in the rehabilitation process are outlined. The use of group therapy techniques for relatives is described and the issues commonly encountered are discussed. The value of the group meetings for relatives and staff is emphasized.
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