Family therapy with an enuretic, encopretic child.

Abstract

This article describes the application of the structural family therapy model to the treatment of an encopretic, enuretic boy and his family. These and other symptomatic behaviors were greatly reduced in a two-session treatment, in which behavioral interventions were designed from a family systems perspective. Therapeutic change involved a significant restructuring of family relationships, in addition to symptomatic relief.Any therapist with a substantial pediatric practice is likely to receive referrals of encopretic and enuretic children from time to time. While these symptoms may be viewed and treated as medical or behavioral problems, the family-oriented therapist is inclined to see them as part of a family systems pathology and to treat them in a family context. There is considerable support in the literature for the efficacy of both medical and behavioral treatments, yet little has been written concerning family-based interventions for enuresis and/or encopresis. This case study describes the application of a family therapy approach to the treatment of a child with these and other problems. The effectiveness of this treatment suggests that in some cases family-based interventions may be even quicker and more complete than traditional behavioral or medical approaches.Typical treatment for enuresis tends to follow one of three strategies (excluding the psychoanalytic approach which uses traditional Freudian methods): 1) chemotherapy; 2) classical conditioning; or 3) operant conditioning. The drug most commonly used and most effective in treating enuresis is imipramine (Tofranil), an antidepressant with anticholinergic and sleep-stabilizing effects. While its success rate is a relatively high 40% or better, imipramine unfortunately also has a very high relapse rate, in addition to unpleasant and potentially dangerous side effects (8). Therefore, many pediatricians are becoming increasingly reluctant to prescribe imipramine, preferring to adopt safer and more effective behavioral approaches. There has been some research on the use of central nervous system stimulants to control enuresis ( 16), but they are not commonly used for this purpose. However, in my experience they often do produce very positive results in children with Attention Deficit Disorder who also