Bowlby remained attached to his psychoanalytic roots and conceptualised treatment in terms of one-to-one relationships, albeit acknowledging the need for a family formulation. Bowlby's five therapeutic tasks were never adapted to the current understanding of working with the relationships fostering the development and maintenance of children's attachment strategies. This paper goes through each of Bowlby's five tasks and adapts them to our current understanding of development, with consequences for prioritising family approaches, rather than a secure base alone with a therapist. In doing so I will review the process of achieving security, seeing it as more similar to an allostatic process than a state of homeostasis.

As there is currently no cure for dementia, providing psycho-social support is imperative. Counselling and psychotherapeutic interventions offer a way to provide individualised support for people with dementia and their families. However, to date, there has not been a systematic review examining the research evidence for these interventions. This review aimed to examine the following research questions: (1) Are counselling/psychotherapeutic interventions effective for people with dementia?, (2) Are counselling/psychotherapeutic interventions effective for care-givers of people with dementia? and (3) Which modes of delivery are most effective for people with dementia and care-givers of people with dementia? A systematic literature search was conducted in MEDLINE (via PubMed), PsycINFO and CINAHL in March 2019. Keyword searches were employed with the terms ‘dement*’, ‘counsel*’, ‘psychotherapy’, ‘therap*’, ‘care’ and ‘outcome’, for the years 2000–2019. Thirty-one papers were included in the review, from seven countries. Twenty studies were randomised controlled trials (RCTs) or adopted a quasi-experimental design. The remaining studies were qualitative or single-group repeated-measures design. The review identified variation in the counselling/psychotherapeutic approaches and mode of delivery. Most interventions adopted either a problem-solving or cognitive behavioural therapy approach. Mixed effectiveness was found on various outcomes. The importance of customised modifications for people with dementia was highlighted consistently. Understanding the dyadic relationships between people with dementia and their care-givers is essential to offering effective interventions and guidance for practitioners is needed. Information about the cognitive impairment experienced by participants with dementia was poorly reported and is essential in the development of this research area. Future studies should consider the impact of cognitive impairment in developing guidance for counselling/psychotherapeutic intervention delivery for people with dementia.

Family therapy is recommended by the National Institute for Health and Care Excellence (NICE) for the management of anorexia nervosa in children and young people, but there is limited evidence to back this recommendation. The Cochrane Review under consideration evaluates the efficacy of different family therapy approaches compared with other treatments for anorexia nervosa, and this commentary puts the findings into clinical perspective.

This study considers the question of whether relapse rates among schizophrenic patients can be reduced by means of relatives' groups. In a randomized, controlled intervention study, two therapeutic strategies (therapeutic relatives' groups, initiated relatives' self-help groups) were compared with each other and with a control group. Interventions were confined to the relatives, with the patients continuing their standard treatment. The study involved 151 relatives of 99 chronic DSMIII schizophrenics. Data were collected before and after a 1-year intervention phase and in a 2-year follow-up. No difference existed between the groups with respect to rehospitalization data. However, numerous differences recorded in the psychopathological findings and in living and working circumstances suggest that therapeutic work with relatives is of clinically significant benefit.

This study reports on the validity of the 15-item Portuguese version of the Systemic Clinical Outcome Routine Evaluation (SCORE-15; Vilaça, Silva, & Relvas, 2014), a brief and comprehensive measure of family functioning. Previous studies with SCORE-15 show that this version replicates the three-factor solution found for the original English version: Family strengths, Family communication and Family difficulties. In addition to reviewing previous studies, this article analyses the discriminant, convergent and predictive validity of the Portuguese SCORE-15. To do so, the SCORE-15 was administered to family members attending systemic family or couple’s therapy at the start of the first and fourth sessions and also to a group of non-clinical individuals. Overall, data are reported from 618 participants, including 136 from families attending systemic therapy and 482 community family members. Comparisons of community and clinical samples (discriminant validity) showed statistically significant differences for the total scale and subscales (p < .001), with the community participants presenting healthier family functioning than the clinical ones. Analyses using SCORE-15 and the Quality of Life – adult version, another family measure applied simultaneously (convergent validity), indicate that both scales are significantly (p < .01) and moderately (r = –.47) correlated. Mean score analysis of SCORE-15’s therapeutic sensitivity to change (predictive validity) showed that only the Family communication subscale was sensitive to statistically significant improvement (p < .05) from session 1 to session 4, whereas the SCORE-15’s reliability change index points to its ability to detect clinical improvements (RCI = 14%).

Traumatised children can be easily dysregulated by relational dynamics. These children often experience the sequential or simultaneous stimulation of attachment and defence characteristic of disorganised/disoriented attachment patterns. Expressing their relational needs for proximity and distance can be fraught with conflict, confusion, frustration and fear. Parents/care-givers are often baffled about how to balance boundaries and limit setting with closeness and proximity in a way that is effective for themselves and their children. Additionally, parents/care-givers themselves may have histories of trauma and attachment failure that impair their own ability to balance closeness and distance. Both proximity seeking or closeness and defense or boundary setting actions are organized by innate, psychobiological systems of attachment and defense, and for parents/caregivers, the caregiving system as well. Each action system has to meet particular goals to achieve proximity to and security with a trusted other (attachment system); to defend and protect when needed (defence systems) and to protect and care for offspring (care-giving system). The legacy of trauma and attachment failure, with their consequential neuropsychological deficits, can constrain and disrupt adaptive responses to the arousal of these three systems. This paper clarifies the inborn systems that drive actions of proximity and distance. A case study will explore the interactions of these systems in child/care-giver therapy. Sensorimotor Psychotherapy will be described and somatic relational techniques will be illustrated to address proximity and defence/boundaries in the context of child therapy and care-giver/child therapy.

The purpose of this study was to investigate differences in family functioning between families with clinical subjects in paediatric age and families taken from the Italian population. To this aim we used the Family Adaptability and Cohesion Evaluation Scale (FACES). Participants were children diagnosed with a psychopathology, recruited into the psychiatry department in a Paediatric Hospital of Rome. A total of 106 families participated in the study. The non-pathological sample is composed by 2,543 parents in different age periods of the life-cycle. Results showed significant differences in family functioning between pathological and non-pathological samples. Specifically, families from the pathological sample (particularly the ones who experienced eating disorders) were more frequently located in extreme or mid-range regions of Olson’s circumplex model (p < .001). These findings suggest some considerations that can be useful in therapeutic works with families in a clinical setting. Critical aspects and clinical applications are discussed.

Therapeutic Residential Care (TRC) has attracted increasing interest in Australia, as a specialised out-of-home care option for children with complex needs. Extending beyond the limitations of traditional residential programmes, TRC aims to address the impact of trauma and promote positive development and wellbeing. The Lighthouse Foundation is a not-for-profit organisation based in Melbourne, providing a long-term programme of TRC to young people aged 15 to 22 at intake. The organisation has developed an attachment and trauma-informed therapeutic community approach, embodied in the Therapeutic Family Model of Care. This discussion paper explores how the therapeutic community approach taken by Lighthouse provides a different experience of the cultural ‘sites’ in which early traumatic experiences occur – including the home environment, experiences of family, and the wider community. In doing so, we propose that an important dimension of TRC is the capacity to challenge traumatic relational blueprints of abuse and neglect. This, in turn, supports children to form and sustain positive and reciprocal relationships, and to live inter-dependently in the community.