Family treatment within a psychodynamic treatment milieu

Family therapy for acute inpatient treatment is invaluable. It serves to support the patient as well as the family through the crisis of hospitalization. On intensive treatment milieus, the family treatment augments the other modalities, furthering the reconstitution of the patient by preventing acting out and splitting, providing a holding environment for the family's anxieties, and supporting their interest and involvement in treatment while educating them about the illness and the aftercare needs. The area of inpatient family therapy is still fledgling. Despite early observations about family pathology stemming from inpatient units, the family treatment focus has shifted to outpatient treatment. This has left a vacuum for clinicians whose primary involvement is in inpatient settings. In the past decade, however, more emphasis has been placed on family-oriented units, but the focus has been primarily on the structure and generalized treatment recommendations or on specific interventions tied to illness categories, that is, schizophrenia, anorexia, substance abuse. Unfortunately, these disparate pieces of work have not led to an overall understanding of how to integrate family concepts and treatment strategies for general psychiatric populations into dynamic treatment units. In order to integrate family treatment into a dynamic milieu, an overall assessment of familial ego functioning, strengths and weaknesses, is necessary. Utilizing an ego psychological perspective renders this assessment integratable into the language and interventions of an intensive treatment unit. Identifying drive-taming capabilities, level of object relations, anxiety tolerance, defenses, and adaptive capacities of the whole family allows for the designation of appropriate interventions. These interventions are tailored toward engaging the family's strengths while limiting the destructive nature of existing pathologies. Treatment interventions are based first on the establishment of familial treatment alliances that can withstand the regressive pull of a psychotic or near-psychotic illness. From this the more traditional therapeutic interventions flow, based on the needs of the case. The focus may be purely informative, educative, and supportive or may be more insight oriented, restructuring. The particular choice of interventions, though, is designated by the strengths and weaknesses identified in the assessment. In this manner we can utilize a biopsychosocial model of treatment that is truly integrated and in which the component parts are understood conceptually by all disciplines.