Family Factors in Failure of Psychotherapy

Abstract

Family factors involved in the failure of psychotherapy for some adolescents and young adults are explored. These treatment failures are distinguished by expulsion of the therapist(s) and by reunification of the previously adversarial patient and parents. Such abrupt terminations may occur when treatment challenges the family's habitual image and understanding of the identified patient. The revolution against therapy appears to result from: (a) an intolerable threat to the family's heretofore stable delineation of the patient, along with (b) the therapist's failure to empathically engage the parents and ease their commitment to that delineation. It is shown how a parallel process can lead to failure in individual, adult psychotherapy. When therapy threatens the patient's familiar but dystonic self-image, and calls for change to a new image that is discordant with the family image of him/her, separation anxiety may precipitate a regressive flight from treatment. Clinical implications are discussed.

Scheitern in der Psychotherapie – der aktuelle Wissensstand

“…In der Tat ist die Debatte um Scheitern in der Psychotherapie innerhalb der Psychotherapieforschung noch nicht sonderlich alt. Immer wieder wurden in der "Frühgeschichte" der Psychotherapie v. a. in der psychoanalytischen Literatur durchaus Gründe für das Scheitern von Behandlungen erörtert, die entweder aufseiten der Patienten (Freud 1937c;Wolman 1972) oder aufseiten der Therapeuten, bezogen auf deren Gegenübertragungsreaktion zu suchen waren (Übersicht bei Gorkin 1987). Auch Rogers (1954) berichtete über einen gescheiterten Fall (des "Mr. Bebb"), dessen Therapie aber interessanterweise von einem anderen Therapeuten als Erfolg gewertet wurde, was zeigt, dass die Definition von Scheitern ein schwieriges Unterfangen sein kann.…”

Treating Adolescents with Family-Based Mindfulness

“…The family is continually engaged in the MDT process, but their problematic beliefs and behaviors are not disputed. Young ( 1991 ) has argued that child and adolescent treatment failures may occur when: Treatment challenges the family's habitual image and understanding of the identifi ed patient. The revolution against therapy appears to result from: (a) an intolerable threat to the family's heretofore stable delineation of the patient, along with (b) the therapist's failure to empathically engage the parents and ease their commitment to that delineation.…”

Análisis de un tipo de intervención terapéutica para niños y adolescentes con trastornos de comportamiento

“…Quizás un análisis más detenido de los casos desde este enfoque teórico puede aportarnos algunas explicaciones para entender los resultados desfavorables que obtuvimos con dos de ellos. Algunos autores (31) han encontrado que el fracaso terapéutico en este tipo de problemas parece estar asociado a que consciente o inconscientemente, el terapeuta había desafiado la imagen que la familia tenía sobre sí misma o sobre su comprensión del problema. Además éste había fracasado en el establecimiento de una relación empática con los padres.…”