Practical application of family and systems theory in old age psychiatry: three case reports

Abstract

The role of the family or carer in old age psychiatry is well acknowledged. However, carer interventions are often focused on addressing carer burden alone and are usually individually rather than family based. Interpersonal conflict and family dynamics are rarely addressed. This is not surprising as there is a paucity of literature in family and systems theory applied to the older person, and clinicians are often skeptical about the efficacy of this treatment mode or daunted by the complexity of family and systems theory. Three cases are presented to illustrate the potential benefits of family-based interventions in the setting of commonly encountered clinical situations: (i) the treatment of chronically depressed older people in the community; (ii) the management of behavioral and psychological symptoms of dementia (BPSD) in residential care; and (iii) home-based support and care of the older patient with dementia.

Carer insights into self‐harm in the very old: A qualitative study

“…In younger people, suicide communication preceding suicide attempts triggers anger, hopelessness, and fear in significant others and may unearth the carer's own psychic conflicts. 16, 25 Benbow and Sharman 22 suggest a pyramid starting with family therapy techniques, progressing to formal family therapy in dementia practice, depending on need. 16,22,25 Family approaches may highlight the potential roles of family members across generations and stages of the life cycle in understanding the cause and maintenance of problems, such as self-harm in the older person, as well as inform treatment.…”

“…16, 25 Benbow and Sharman 22 suggest a pyramid starting with family therapy techniques, progressing to formal family therapy in dementia practice, depending on need. 25 25 Previous work has focused on carer burden in isolation, rather than based within a family system.…”

“…16 Family therapy may be under-utilized for older people, despite established associations between interpersonal conflict and mental distress. 16,22,25 Family approaches may highlight the potential roles of family members across generations and stages of the life cycle in understanding the cause and maintenance of problems, such as self-harm in the older person, as well as inform treatment. 16,25 Benbow and Sharman 22 suggest a pyramid starting with family therapy techniques, progressing to formal family therapy in dementia practice, depending on need.…”

“…16,22,25 Family approaches may highlight the potential roles of family members across generations and stages of the life cycle in understanding the cause and maintenance of problems, such as self-harm in the older person, as well as inform treatment. 16,25 Benbow and Sharman 22 suggest a pyramid starting with family therapy techniques, progressing to formal family therapy in dementia practice, depending on need. 16 Understanding carer projections onto health professionals of carer burden, guilt, and inadequacy may enable more sensitive and effective responses of clinicians.…”

“…16 Understanding carer projections onto health professionals of carer burden, guilt, and inadequacy may enable more sensitive and effective responses of clinicians. 25 Previous work has focused on carer burden in isolation, rather than based within a family system. 25,26 otherwise.…”