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Carr, Alan
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Carr, Alan
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Carr, Alan
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- PublicationThe effectiveness of family therapy and systemic interventions for child-focused problemsThis review updates a similar paper published in the Journal of Family Therapy in 2001. It presents evidence from meta-analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family-based approaches such as parent training. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for sleep, feeding and attachment problems in infancy; child abuse and neglect; conduct problems (including childhood behavioural difficulties, ADHD, delinquency and drug abuse); emotional problems (including anxiety, depression, grief, bipolar disorder and suicidality); eating disorders (including anorexia, bulimia and obesity); and somatic problems (including enuresis, encopresis, recurrent abdominal pain, and poorly controlled asthma and diabetes).
14292Scopus© Citations 154 - PublicationThematic review of family therapy journals 2007In this paper the principal English-language family therapy journals published in 2007 are reviewed under these headings: child-focused problems, adult-focused problems, couples, divorce, diversity, developments in systemic practice, assessment, training, research, international professional developments and deaths.
484Scopus© Citations 3 - PublicationIrish child sexual abuse victims attending a specialist centreWe profiled a cohort of CSA cases referred for assessment to a specialist child sexual abuse (CSA) centre in a national paediatric hospital in Ireland. Historical and clinical data were drawn from records of 171 cases. The majority of cases were referred by social workers following purposeful disclosure of CSA. Three quarters of the cases were female with a mean age of 9 years. They were from a wide spectrum of socioeconomic groups and many had suffered a range of family adversities. In most cases, the abuse involved masturbation of the child by the abuser. Almost all of the perpetrators were male with a mean age of 28 years and in 60% of cases extrafamilial abuse had occurred. In 23% of cases, the perpetrator had a history of previous sexual offending. Anxiety was the most common emotional problem before disclosure and after disclosure the most common emotional problem was guilt. Before disclosure school refusal was the most common behavioural problem and after disclosure fighting was the most prevalent behavioural difficulty. The most common factors supporting the credibility of CSA allegations were labile mood, the child's ability to differentiate fact from fantasy and a detailed disclosure of contextual details. More adolescents showed deterioration in schoolwork after disclosure and for more pre school children clinginess following disclosure was a significant emotional problem. More primary school aged children were abused by perpetrators who had abused a number of children. For children abused by such perpetrators, vaginal intercourse was less common. Vaginal intercourse was more common in 6–11-year-old victims and those who were abused on a daily basis. The threat that disclosure posed to the integrity of the family structure was more often a factor hindering disclosure in victims abused by father figures and abused very frequently.
665 - PublicationThematic review of family therapy journals in 2013In this article the contents of the principal English-language family therapy journals and key family therapy articles published in other journals in 2013 are reviewed under these headings: models of family therapy, developments in family therapy practice, couple therapy, training, diversity, international developments, research and DSM-5.
384Scopus© Citations 1 - PublicationHelping children to the other side of silence: A study of the impact of the stay safe programme on Irish children's disclosures of sexual victimisation.Objective. This study aimed to evaluate the effectiveness of a school based safety skills programme - The Stay Safe Programme - in facilitating the disclosure of sexual abuse among sexually victimized children and adolescents in Dublin. Method. A cohort of 145 children who had participated in the Stay Safe Programme prior to their referral to a sexual abuse assessment unit were compared with a cohort of 443 children who had not participated in the prevention programme on a range of disclosure related variables abstracted from case notes. Results. More Stay Safe participants, particularly female adolescents, made disclosures of suspected sexual abuse than non-participants. A higher rate of initial disclosure to teachers was made by Stay Safe participants and more teachers in schools participating in the Stay Safe programme initiated referrals for evaluation of suspected child sexual abuse. Following assessment a higher rate of confirmed abuse occurred among Stay Safe participants and for these confirmed cases more Stay Safe participants made purposeful disclosures and in significantly more cases referral was due to the child telling someone about the abuse. These differences in disclosure between programme participants and non-participants were unrelated to demographic factors or characteristics of the abuse. Conclusions. The Stay Safe programme was an effective secondary prevention intervention deserving widespread implementation.
353Scopus© Citations 26 - PublicationFamily and marital profiles of couples in which one partner has depression or anxietyTwenty-nine couples in which one partner was depressed, 21 couples in which one partner had an anxiety disorder, and 26 nondistressed control couples were compared on measures of (1) quality of life, stress, and social support; (2) family functioning; (3) marital functioning; and (4) relationship attributions. The depressed group had significant difficulties in all four domains. In contrast, the control group showed minimal difficulties. The profile of the anxious group occupied an intermediate position between those of the other two groups, with some difficulties in all four domains, although these were less severe and pervasive than those of the depressed group..
519Scopus© Citations 18 - PublicationYoung women at risk for eating disorders: perceived family dysfunction and parental psychological problemsThese results of this study are consistent with theories of eating disorders that highlight the role of family factors in the etiology and maintenance of eating disorders. When 27 young women at risk for eating disorders who scored above the clinical cut-off score on the EDI-II were compared with age and SES matched controls, they were found to obtain more dysfunctional scores on the Family Assessment Device and on ratings of perceived maternal and paternal symptomatology on the SCL-90-R.
572Scopus© Citations 18 - PublicationPsychosocial profiles of Irish children with conduct disorders, mixed disorders of conduct and emotion and emotional disordersThis paper reports on a retrospective archival study. Forty-one conduct disorder cases, 20 cases with mixed disorders of conduct and emotions and 23 emotional disorder cases were compared on demographic, behavioural and contextual variables. The pattern of treatment received by each group and their therapeutic outcomes were also compared. The three groups had similar demographic characteristics but distinctive psychosocial profiles. Conduct disordered cases showed a predominance of covert behaviour problems and came from anomalous family situations with inadequate parental control. They received family therapy and were more likely to drop out of treatment. Mixed disorder cases showed more behaviour problems overall and more overt behaviour problems. They came from families where there was inadequate parental control and anomalous family situations. They received more child focused individual therapy and parent focused therapy than other cases. Emotional disorder cases showed fewer behavioural problems overall and fewer overt behavioural problems in particular. These cases tended to be characterized by familial overinvolvement in the child’s problems. They received family therapy and child focused therapy and showed greater improvement than cases from the other diagnostic groups.
547Scopus© Citations 3 - PublicationResistance, dilemmas and crises in family therapy: a framework for positive practiceWhen clients believe that they have not got the personal resources to cope with the demands of either living with their problems or taking steps towards the resolution of these, stating their therapeutic dilemma may precipitate a therapeutic crisis. A therapeutic dilemma is a concise statement of the disadvantages and difficulties associated with leaving the presenting problem unresolved and the disadvantages and risks entailed by solving the problem. Invariably, therapeutic crises involve some family members doubting an interactional formulation of the family's problems and redefining these as individual difficulties of a specific family member. That is, someone in the family becomes defined as bad, sad, sick or mad. The pressure to collude with the family and other network members in abandoning an interactional construction of the problem and accepting an individual description is usually very intense. When therapists follow this route they become part of the problem maintaining system. In this paper a framework for conceptualizing therapeutic crises and guidelines for their management are described. These guideline allow the therapist to avoid becoming involved in problem maintenance and to retain a position from which to promote problem resolution. The framework and guidelines evolved within the context of a brief integrative approach to consultation with families who require help with child-focused psychosocial difficulties.
Scopus© Citations 2 289 - PublicationThe Beavers, McMaster and Circumplex Clinical Rating Scales: A study of their sensitivity, specificity and discriminant validityTo asses the sensitivity and specificity of clinical rating scales from the Beavers, McMaster and Circumplex models of family functioning videotapes of 60 families engaging in a standardized family task interview were rated using the three rating scales. The 60 families included 20 containing a child with an emotional disorder, 20 containing a child with a mixed disorder of emotions and conduct; and 20 in which none of the children presented with clinically significant difficulties. The three rating scales accurately classified 85-90% of normal controls; 70-90% of cases containing a child with a mixed disorder of emotions and conduct; and 55-65% of families containing a child with an emotional disorder. On the rating scales, the Beavers and McMaster models showed particularly high levels of sensitivity in detecting clinical cases, whereas the Circumplex rating scale was particularly good at classifying nonclinical cases accurately.
523Scopus© Citations 14