Family, Group, and Community Interventions
What to know
Family systems concepts: homeostasis, boundaries, roles, enabling, codependency (use with caution), and family therapy models (structural, strategic, multisystemic therapy for adolescents, behavioral couples therapy - strong evidence). Group therapy: stages (forming, storming, norming, performing), therapeutic factors (Yalom: universality, instillation of hope, universality, interpersonal learning), and group rules (confidentiality, attendance). Community interventions: prevention coalitions, environmental strategies (policy, availability), community reinforcement approach, and SBIRT in community settings. Understand cultural humility and family involvement in recovery. Know the evidence base for behavioral couples therapy and multidimensional family therapy.
Traps
Questions overstate codependency as a formal diagnosis - it is not in DSM. Watch for items suggesting family members should always be excluded from treatment (family involvement often improves outcomes). Distinguish enabling (protecting from consequences) from support. Note group confidentiality limits (members are asked, not legally bound, to keep confidentiality).
Rule of thumb
Involve family when safe and appropriate - behavioral couples therapy and family therapy have strong evidence. Screen for intimate partner violence before couples work.
Worked example
An adolescent with cannabis use disorder and family conflict: multidimensional family therapy addresses both the adolescent's use and family functioning, with better outcomes than individual therapy alone.