What works for therapists conducting family meetings: treatment integrity in family-focused grief Therapy during palliative care and bereavement

Abstract

The purpose of this study was to evaluate the treatment integrity of Family-Focused Grief Therapy (FFGT), a preventive intervention designed for families at high risk of poor functioning during palliative care and bereavement. From the 81 families participating in a randomized controlled trial (53 assigned to therapy), 28 were randomly selected for this study of treatment fidelity using the FFGT integrity measure. A total of 109 family sessions were appraised. This represented a review of 62% of treated families, 38% of total therapy sessions, and 87% of the 15 participating therapists. Weighted mean percentage occurrences of therapist behaviors permitted trends in therapy application to be observed. Inter-rater reliability using the FFGT integrity measure was satisfactory, with 88% overall agreement. Eighty-six percent of therapists adhered faithfully to core elements of the model. Therapist competence was evidenced by a strong therapeutic alliance (94%), affirmation of family strengths in over 90%, and focus on agreed themes in 76% of sessions. Therapists averaged 10 grief-related questions per session, 7 on communication-related issues during assessment, 7 on conflict late in therapy, and 4 on cohesiveness across the course of therapy. Consistent application of FFGT, with attention to its four key themes of family communication, cohesiveness, conflict resolution, and shared grief has been demonstrated. The model is generalizable when applied by family therapists.

Family characteristics and dynamics: A systems approach to grief

“…Groot, Neeleman, Van Der Meer, and Burger (2010), in a randomized controlled trial of family-based cognitive behavior grief therapy on suicide survivors, found that FBP's impact was moderated by suicidal ideation 13 months post-loss. In emphasizing the enhancement of family cohesion, communication, and conflict resolution through the sharing of grief as measured by the Family Environment Scale (Moos & Moos, 1994), Chan O'Neill, McKenzie, Love, and Kissane (2004) verified the adherence of therapists to Family-Focused Grief Therapy (FFGT, see Kissane & Bloch, 2002) during palliative care and after death. Such adherence is a key to establishing treatment efficacy.…”

Challenges in providing family-centered support to families in palliative care

“…17 While some items rate the presence or absence of events and therapist's behaviors, others record the number of questions asked about a theme – primarily patterns of family communication, conflict, cohesiveness and grief. A coding manual defined each item, including explicit guidelines for rating each item.…”

Family focused grief therapy: a versatile intervention in palliative care and bereavement

“…Delivery of the therapy is standardised with a manual, extensive training and supervisory support (Chan et al , 2004). Therapists have been masters and PhD-level clinicians with post graduate training as family therapists (Del Gaudio et al , 2011).…”