Psych CASC / OSCE · Child and adolescent psychiatry — family assessment and therapy
Engage high-conflict parents and match family therapy — CASC communication station
MRCPsych/FRANZCP-style CASC: non-blaming engagement, FBT rationale, medical safety, refuse coercive holding, manage parental split without triangulation.
On this page & tools
Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time. You are the CAMHS psychiatry registrar. [1]
Candidate instructions. Engage both parents without taking sides; prioritise medical safety; explain family-based treatment as empowering parents against the illness (not blaming them as the cause); refuse coercive holding at meals; outline next concrete steps (medical review pathway, FBT orientation, crisis plan); check understanding. [1][2][3]
Candidate scenario
Working diagnosis is adolescent restricting anorexia with medical risk and high parental conflict/split. Individual therapy alone is a weaker first-line frame than FBT for adolescent AN. Holding/restraining for "attachment" is unsafe and unsupported. You must avoid triangulation and keep the illness externalised. [1][3][4]
Marking domains
- Empathy and multi-partiality (both parents feel heard)
- Clear medical-risk priority and pathway
- Accurate plain-language FBT rationale (parents as resource, not villains)
- Explicit refusal of coercive holding practices
- Manage parental split without joining a coalition
- Shared plan and safety net [1][2][3]
Reveal assessor key
Open. Name time; acknowledge fear and conflict; ask each parent's top priority; set agenda including safety.[1]
Safety. State that medical risk comes first — urgent medical/paediatric review and monitoring plan before therapy debates. Family work supports recovery but does not replace medical care.[2]
Reframe. "The problem is the anorexia taking control of meals and energy — not that you are bad parents. The best-tested outpatient psychosocial approach for adolescents empowers parents to lead refeeding together, then gradually returns control." Cite FBT evidence in plain language (better full-remission outcomes than adolescent-only therapy in key trials).[1][4]
Split. Do not side with soft vs strict. Ask both to form a united stance against the illness; offer brief separate caucuses if escalation blocks work. Avoid therapist triangulation.[5]
Refuse holding. Forced holding/restraint as "therapy" is not recommended, can be harmful, and we will not use or refer for it. Offer structured meal-support coaching within FBT principles instead.[3]
Close. Summarise medical steps, FBT orientation appointment, crisis contacts, written plan, invite questions. [1][2]
References
- [1]Lock J, Le Grange D, Agras WS, et al. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa Arch Gen Psychiatry, 2010.PMID 20921118
- [2]Hay P, Chinn D, Forbes D, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders Aust N Z J Psychiatry, 2014.PMID 25351912
- [3]Chaffin M, Hanson R, Saunders BE, et al. Report of the APSAC task force on attachment therapy, reactive attachment disorder, and attachment problems Child Maltreat, 2006.PMID 16382093
- [4]Couturier J, Kimber M, Szatmari P Efficacy of family-based treatment for adolescents with eating disorders: a systematic review and meta-analysis Int J Eat Disord, 2013.PMID 22821753
- [5]Retzlaff R, von Sydow K, Beher S, et al. The efficacy of systemic therapy for internalizing and other disorders of childhood and adolescence: a systematic review of 38 randomized trials Fam Process, 2013.PMID 24329407