Exploring the benefits of family therapy for young people in crisis
Over her 30-year career as a clinical social worker – almost 20 of those with the Child Youth Mental Health Service (CYMHS) at Northern Sydney Local Health District (NSLHD) – Dr Di Simes had seen youth suicide rates initially stabilise.
But in recent years, those rates have begun to rise, particularly among girls and younger children. Concerned, Di turned to research on what makes a difference in tackling what is tragically the leading cause of death for children and young people aged 5-24 years in Australia. While no single treatment stood out as clearly superior, studies highlighted several key factors for effective intervention: involving family and caregivers; beginning fairly intense therapy early; focusing on coping skills to improve safety; building strong engagement; and strengthening the caregiver-youth relationship.
Di’s research formed the basis of a PhD in psychology at the Queensland University of Technology under the supervision of Professor Ian Shochet, a leading expert in adolescent depression research. Through interviews with seven different “trios”, Di made several key findings. Individual and family therapy benefits Firstly, she found clear benefits to including parents in their children’s treatment – through individual sessions for both youth and parents, as well as joint therapy. “The research strongly supports moving away from siloed treatment,” says Di. At the beginning of a crisis, “it was very much a picture of fractured relationships with young people feeling isolated in their suicidality and parents basically feeling helpless and also sometimes quite misattuned in how they try to support their child”. Participants felt that the private mental health system promoted an individual therapy model which wasn’t necessarily the best way forward. In one example, she interviewed a 12-year old girl who had been self-harming for four years but had only ever seen a therapist on her own.
“Still, there were lots of knowledge gaps,” she says.
A 2022 review of qualitative research by Di and colleagues identified no research capturing both young people’s and caregivers’ perspectives on what aspects of family based treatment for youth suicidality were helpful or unhelpful. Wanting to fill those gaps, Di led a world-first qualitative study on family-based youth suicide intervention, speaking with 24 participants – young people aged 12-18, their parents, and therapists – about their experience of treatment.
“It actually exacerbated her sense of isolation,” says Di.
“Young people often felt quite connected with their therapist but individually reported that they felt less understood by their parents more isolated. Parents reported consistently feeling shut out.”
14 Tomorrow’s medicine today
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