Redefining the role of family therapy in psychiatric residency education.

In order to learn how psychiatry residents use family therapy training from residency in their clinical practices after graduation, the authors interviewed graduates from a large program in the metropolitan Northeast and a small program in the rural South. Graduates from both programs were using family therapy theory and skills to a greater extent than they had anticipated during residency. However, these skills were being used primarily to treat individual patients and to solve clinical and administrative problems in settings other than traditional couple and family therapies. Based on the findings, the authors suggest a restructuring of content and redefinition of role for family therapy training in psychiatry residencies.

Mind-body problems in family therapy: contrasting first- and second-order cybernetics approaches.

Using detailed case examples, we contrast first- and second-order cybernetics approaches to family problems involving somatic symptoms in a family member. A second-order cybernetics approach views the reality of the problem as linguistically shaped by those interacting around it, including the therapist and observing team members. This co-constructed reality, the story of the problem, inadvertently contributes to the problem's endurance by narrowing the choice of more effective solutions. In our approach, the therapist elicits from each person his or her story about the illness in the family. The therapist then facilitates a therapeutic conversation that provides a context for new linguistic distinctions to be drawn, including the way mind and body may interact to generate the symptoms. Shifts in beliefs and behaviors follow, and more innovative solutions to the problem can then emerge. Unlike the approach in our previously published work based upon ecosystemic patterns as "system diagnoses," this approach uses only descriptions and explanations of the problem as are collaboratively constructed within this therapeutic conversation.

Mind-body patterns of symptom generation.

Effective ways for joining family therapy with other treatment modalities are becoming increasingly important as the efficacy of family therapy gains acceptance in the medical and mental health community. When one interfaces family therapy with medical and psychopharmacological treatments, which find the sources of symptoms within individuals, rather than interpersonal systems, careful attention must be paid to the mind and body relationships that guide interactions between family behavior and the somatic physiology of each family member. We present six mind-body patterns of symptom generation found to be particularly useful for designing multimodality treatments and for communicating the treatment rationale to medical and psychiatric clinicians or to family members. Case examples illustrate their clinical use.

Münchausen syndrome by proxy and sleep disorders medicine.

Münchausen syndrome by proxy is a factitious disorder of childhood in which a parent fabricates medical history or produces signs of illness in a child to keep the child in a sick role. Since approximately half of all cases of Münchausen syndrome by proxy are presentations of central nervous system illness, such as excessive daytime sleepiness and near-miss sudden infant death syndrome, sleep disorders centers are likely diagnostic consultants for the evaluation of children involved in this disorder. We review characteristics that may suggest that a particular case has an increased likelihood of Münchausen syndrome by proxy. The recent presentations of two cases of Münchausen syndrome by proxy to sleep disorders centers are discussed as examples.