Josephson Allan M
Division of Child and Adolescent Psychiatry, University of Louisville, Louisville, KY, USA.
Acad Psychiatry. 2008 Sep-Oct;32(5):405-13. doi: 10.1176/appi.ap.32.5.405.
This article discusses the pedagogy of teaching family therapy in the new millennium. It draws on the strengths of "family systems therapy" but goes beyond it-suggesting a new paradigm, new terminology, and a new teaching perspective. It discusses the historical background of family therapy training, a scientific foundation for what residents should be taught, and an integrative clinical model for how it could be taught.
The article is the synthesis of the perspectives and experience of a child and adolescent psychiatrist educator who began his career at the end of the systemic era in psychiatry and continues it through the developments of the neurobiologic era. It draws on selected literature from the fields of family therapy, child and adolescent psychiatry, developmental psychopathology, and general psychiatry.
This article submits that the term "family therapy" should be replaced by the term "family intervention"; the evidence base indicates that family interventions are effective; family risk and protective factors influence the onset and course of disorders; families help shape and maintain cognitive schema; intervention must start with thorough case formulation; and family interventions should be coordinated with other interventions, include parent management training, and build on family strengths.
Family intervention is an important clinical process in child and adolescent psychiatry, and contemporary education must address the multiple ways clinicians can assist families. Future models will be successful to the degree they build on the past contributions of systems thinking and include the perspectives of developmental psychopathology. Contemporary education should teach that family interventions are not optional but ideally can be integrated with other interventions in a sequential manner, emphasizing the interrelationship between self and system.
本文探讨了新千年家庭治疗教学的教学法。它借鉴了“家庭系统治疗”的优势，但又超越了它，提出了一种新的范式、新的术语和新的教学视角。本文讨论了家庭治疗培训的历史背景、应教授给住院医师内容的科学基础，以及如何进行教学的综合临床模型。
本文综合了一位儿童和青少年精神科教育工作者的观点和经验，他在精神病学的系统时代末期开始职业生涯，并经历了神经生物学时代的发展。本文借鉴了家庭治疗、儿童和青少年精神病学、发展性精神病理学以及普通精神病学领域的部分文献。
本文认为“家庭治疗”一词应被“家庭干预”所取代；证据表明家庭干预是有效的；家庭风险和保护因素会影响疾病的发生和发展过程；家庭有助于塑造和维持认知模式；干预必须从全面的病例制定开始；家庭干预应与其他干预措施相协调，包括家长管理培训，并基于家庭优势展开。
家庭干预是儿童和青少年精神病学中的一个重要临床过程，当代教育必须涵盖临床医生帮助家庭的多种方式。未来的模式只有在借鉴系统思维过去的贡献并纳入发展性精神病理学观点的程度上才会成功。当代教育应教导人们，家庭干预并非可有可无，理想情况下可以与其他干预措施按顺序整合，强调自我与系统之间的相互关系。
