Family assessment and therapy in CAP — indication matching and safe practice (MEQ) · Psych MEQs / SAQs

Prompt

You are the CAMHS registrar. Three families are booked in one afternoon: (A) a 15-year-old with restricting anorexia nervosa and medically concerning weight whose parents feel helpless; (B) a 5-year-old with severe ODD and coercive parent–child cycles; (C) a 16-year-old with depression, suicidal ideation, and emotional cut-off from her mother. A fourth parent emails asking for paid holding therapy for their adopted child. (i) Outline a structured CAP family assessment applicable to all cases. (ii) Match the best evidence-based family package to A, B, and C with brief rationale and key session elements. (iii) State absolute safety limits on conjoint work. (iv) Respond to the holding-therapy request with APSAC-aligned reasoning. (v) Name two fidelity/prognosis points for real-world delivery. (20 marks)

Model answer

Reveal model answer

(i) Assessment. Safety first every time (abuse/neglect, IPV, suicide, medical risk). Confidentiality contract with adolescents. 3-generation genogram; structural map (hierarchy, boundaries, triangulation); circular questions for sequences without linear blame; multi-informant diagnosis of the index child; EE proxies and warmth; accommodation screen when OCD/anxiety present; carer mental health and school collateral. Family work never replaces diagnosis or safeguarding.[6][7]

(ii) Matching — diagnosis-matched packages (not one generic family chat):

A (adolescent AN): FBT — parents lead refeeding (phase 1), then return of control, then adolescent issues; superior full-remission outcomes vs adolescent-focused individual therapy in landmark RCT; concurrent medical monitoring.[1]
B (preschool ODD): PCIT (or intensive behavioural parent training) — CDI then PDI with live coaching; meta-analytic support for reducing externalising behaviour; target coercive cycles.[2]
C (depression + SI + cut-off): ABFT — relational reframe, alliance building, attachment tasks, autonomy promotion; RCT support for reducing suicidal ideation and depressive symptoms vs enhanced usual care, plus individual risk plan.[3]

(iii) Safety limits. Do not run conjoint communication sessions with active IPV/coercive control or when free speech is unsafe — separate, protect, report under local law. Acute medical or suicide risk: stabilise the child first. Statutes are jurisdiction-specific.[4]

(iv) Holding therapy. Explicitly refuse coercive holding/rebirthing/forced-regression therapies as unproven and potentially dangerous (APSAC). Offer non-coercive caregiving support and evidence-based alternatives; no medication creates attachment.[4]

(v) Fidelity/prognosis. Real-world benefit of packages such as functional FFT depends on therapist adherence; manualised delivery, homework, and multiagency intensity improve outcomes versus unstructured chats. Systemic therapy has broader RCT support but viva answers still match named packages to indications.[5][6]

Common errors

Offering the same generic family meeting to AN, ODD, and SI cases instead of FBT/PCIT/ABFT matching
Starting conjoint work despite IPV red flags
Endorsing coercive holding therapies contrary to APSAC
Forgetting medical monitoring in adolescent AN
Blaming parents as sole aetiology rather than formulating circular patterns These traps fail fellowship stations that expect package matching, safety-first practice, and non-coercive care.[1][4][6]

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]Thomas R, Abell B, Webb HJ, et al. Parent-Child Interaction Therapy: A Meta-analysis Pediatrics, 2017.PMID 28860132
[3]Diamond GS, Wintersteen MB, Brown GK, et al. Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial J Am Acad Child Adolesc Psychiatry, 2010.PMID 20215934
[4]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
[5]Sexton T, Turner CW The effectiveness of functional family therapy for youth with behavioral problems in a community practice setting J Fam Psychol, 2010.PMID 20545407
[6]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
[7]Calvocoressi L, Lewis B, Harris M, et al. Family accommodation in obsessive-compulsive disorder Am J Psychiatry, 1995.PMID 7864273

Model answer

Reveal model answer

(ii) Matching — diagnosis-matched packages (not one generic family chat):

A (adolescent AN): FBT — parents lead refeeding (phase 1), then return of control, then adolescent issues; superior full-remission outcomes vs adolescent-focused individual therapy in landmark RCT; concurrent medical monitoring.[1]
B (preschool ODD): PCIT (or intensive behavioural parent training) — CDI then PDI with live coaching; meta-analytic support for reducing externalising behaviour; target coercive cycles.[2]
C (depression + SI + cut-off): ABFT — relational reframe, alliance building, attachment tasks, autonomy promotion; RCT support for reducing suicidal ideation and depressive symptoms vs enhanced usual care, plus individual risk plan.[3]

Common errors

Offering the same generic family meeting to AN, ODD, and SI cases instead of FBT/PCIT/ABFT matching

Starting conjoint work despite IPV red flags

Endorsing coercive holding therapies contrary to APSAC

Forgetting medical monitoring in adolescent AN

Blaming parents as sole aetiology rather than formulating circular patterns These traps fail fellowship stations that expect package matching, safety-first practice, and non-coercive care.[1][4][6]

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]Thomas R, Abell B, Webb HJ, et al. Parent-Child Interaction Therapy: A Meta-analysis Pediatrics, 2017.PMID 28860132
[3]Diamond GS, Wintersteen MB, Brown GK, et al. Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial J Am Acad Child Adolesc Psychiatry, 2010.PMID 20215934
[4]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
[5]Sexton T, Turner CW The effectiveness of functional family therapy for youth with behavioral problems in a community practice setting J Fam Psychol, 2010.PMID 20545407
[6]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
[7]Calvocoressi L, Lewis B, Harris M, et al. Family accommodation in obsessive-compulsive disorder Am J Psychiatry, 1995.PMID 7864273