Atwood N
Smith College School for Social Work, Brookline, MA.
Am J Psychother. 1990 Apr;44(2):247-55. doi: 10.1176/appi.psychotherapy.1990.44.2.247.
Most clinicians favor family involvement in the treatment of adult outpatients who are at risk for major mental illness. New models for the family-oriented treatment of mental illness, particularly schizophreania, are, however, not readily adaptable to the situations encountered by practitioners working in clinics or private offices where one-to-one psychotherapy is the norm. This article describes a clinical model that is compatible with such an individualized outpatient practice (particularly for outpatients who are living with their family of origin or a spouse). The innovative feature of this model is the integration of the patient's family into the ongoing treatment on a regular basis, while continuing to maintain the primary focus on the patient and the therapist-patient relationship. To maintain a balanced response to the needs of both patient and family, prevent patient paranoia and family intrusiveness, and facilitate prompt and effective containment for patient losses of control, this model puts into place several mechanisms: (1) the scheduling of family meetings at predetermined times; (2) the establishment of protocol for handling unanticipated phone calls from family members; and (3) the creation of a three-way therapist-patient-family contract for dealing with incipient emergencies.
大多数临床医生赞成让家庭参与对有患重大精神疾病风险的成年门诊患者的治疗。然而，针对精神疾病尤其是精神分裂症的以家庭为导向的治疗新模式，并不容易适用于在诊所或私人办公室工作的从业者所面临的情况，在这些地方一对一心理治疗是常态。本文描述了一种与这种个体化门诊实践（特别是针对与原生家庭或配偶一起生活的门诊患者）相兼容的临床模式。该模式的创新之处在于将患者的家庭定期纳入正在进行的治疗中，同时继续将主要重点放在患者以及治疗师与患者的关系上。为了对患者和家庭的需求保持平衡的回应，防止患者产生偏执和家庭的侵扰，并便于对患者失去控制的情况进行迅速有效的控制，该模式建立了几种机制：（1）在预定时间安排家庭会议；（2）制定处理家庭成员意外来电的规程；（3）制定治疗师 - 患者 - 家庭三方合同以应对初期紧急情况。
