The Psychosocial Effects of Systemic / Family Constellation

Completed

Conditions: Mild to Moderate Psychopathological Symptoms

Interventions: Behavioral: Systemic / family constellation

Registration Number: NCT03233958

Lead Sponsor: Károli Gáspár University of the Reformed Church in Hungary

Brief Summary: The purpose of this study is to investigate the psychosocial effects of systemic / family constellation. The method of systemic / family constellation refers to an approach which integrates ideas from family systems therapy with elements from psychodrama. The constellations are conducted in a group based seminar-setting, each seminar lasting two days.

Considering the very limited amount of empirical data on this method, the study design is a simple pre-post one with a 6-months follow-up. The study will be observational: the researchers will not manipulate who receives the intervention; instead they invite all clients (individuals from the general population) attending these therapeutic workshops run independently of the research process. Given the limited amount of evidence on this therapeutic method, special attention will be given to monitor potential adverse outcomes to establish intervention safety.

It is hypothesized that participation in a family constellation seminar might decrease potential psychological symptoms and will not result in adverse outcomes.

Detailed Description: Family / systemic constellation therapy is a short-term group psychotherapy aiming to help clients better understand and resolve their conflicts within their personal systems, which in turn might lead to a decrease in psychopathological or functional somatic symptoms. The personal system addressed is most often the family but other inter- or intrapersonal systems (e.g., ego parts, victim-perpetrator dyads) can also be the target of the intervention; the term "family constellation therapy" is used throughout the manuscript in this broader sense. This therapeutic modality was developed in Germany in the early '90s integrating elements of - among others - psychodrama, family sculptures, contextual therapy, and certain South-African aboriginal traditions and has become particularly popular in Europe and South America and even became part of the public health care system in certain countries. Compared to its use by thousands of therapists of various theoretical and professional backgrounds all over the world, little effort has been made to generate empirical data regarding the effectiveness and safety of this intervention.

We believe that the large discrepancy between the relatively high level of penetration into the practice of complementary and alternative medicine versus the low quantity of evidence on effectiveness stems largely from academic psychology's reluctance to engage with at least two metaphysical / anthropological postulates of family constellation therapy. Firstly, the theory of family constellation therapy assumes that an individual's mental and physical health might be significantly influenced by major life events of other members of the personal system even if they lived generations before (e.g., the death of a mother during childbirth might have an effect on her descendants' anxiety level and reproductive success for several generations even if the original event has never been talked about in the descendant's life). While - due to recent developments in epigenetics and the better understanding of transgenerational trauma - this and similar concepts are less shocking to the academic community than they were 3-4 decades ago when family constellation therapy was developed, they are still in sharp contradiction with the common understanding that the etiological factors of any physical or mental illness are to be sought in bio-psycho-social events, situations, or conditions occurring or existing around and after the individual's conception.

The second distinctive feature is that the theory of family constellation therapy assumes that the life-altering, relevant pieces of information are 'stored' and somehow can be 'downloaded' not just automatically and unconsciously by the members of the same system but intentionally by outsiders as well. This accessibility of system-relevant information makes it possible that participants of the single-occasion intervention (who are unknown to each other) are able to perceive and verbalize thoughts, physical perceptions, emotions associated with the history of the system, often unknown even to the recipient of the given constellation. This somewhat 'mystical' re-presentation of unknown facts and hidden dynamics makes it possible for the recipient of the constellation to better understand the etiology of their mental or physical symptoms and intentionally change these very same dynamics. How this storage and access of system-relevant information occurs is highly debated and uncertain; the most-widely held explanation of these processes use the morphic / morphogenic field and -resonance concepts (cf. storage) of the biologist Rupert Sheldrake in combination with the function of mirror neurons (cf. way of accessing stored information by non-members of the system).

Regardless of whether we fully understand the exact mechanisms of action of a therapeutic modality and if its certain assumptions fit the contemporary paradigms of health sciences, we argue that collecting empirical data on an intervention's effectiveness and safety is a public health necessity, especially if it is so widely used as family constellation therapy (and it certainly could provide further impetus to the study of the mechanisms of action and the potential reconsideration of the accuracy of our paradigms).

The very limited number of previous prospective, peer-reviewed studies into family constellation therapy's therapeutic effectiveness reported that the intervention was effective in reducing general, non-diagnosis-specific psychopathology and psychological distress, decreasing the intensity of dermatological symptoms, as well as improving quality of life and functioning in interpersonal relationships. A recent systematic review summarizing both the peer-reviewed and the grey literature on family constellation therapy concluded that further studies into its effectiveness are greatly needed, especially if 1) using at least a mid-term time frame (≥6 months) to evaluate client outcomes, 2) employing active monitoring (not just passive surveillance) of potential iatrogenic effects, and 3) providing information on the presence or absence of therapist effects. The aim of the present study was to collect and analyze further data from the real life setting on family constellation therapy's effectiveness in improving mental health and its tolerability in line with these recommendations.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 182

Inclusion Criteria

Self-referred and registered for a family constellation workshop with one of the therapists (clinical psychologist / psychiatrist) who were willing to collaborate with the researchers of the present study

Exclusion Criteria

Age under 18 years
Currently suffers from a diagnosed mental disorder
Participated actively (not merely as a "representative") in a family constellation intervention in the 12 months preceding baseline assessment

Study & Design

Study Type: OBSERVATIONAL

Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Workshop participants	Systemic / family constellation	Participants of systemic / family constellation workshops

Primary Outcome Measures

Name	Time	Method
Change in General Severity Index Scores on the Brief Symptom Inventory	Before, 1- and 6-month after the intervention	The Hungarian version of the Brief Symptom Inventory was used to measure an individual's overall psychopathology level. This tool consists of 53 items covering nine symptom dimensions: somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. Out of the three global measures of pathology and distress, the General Severity Index (GSI, mean of all items) was used in the present study. The range of this measure is 0-4, higher scores indicating worse mental health (more psychopathological symptoms). The range of this measure is 0-4, higher scores indicating worse mental health (more psychopathological symptoms).

Secondary Outcome Measures

Name	Time	Method
Change in Scores on the Experience in Personal Social Systems Questionnaire	Before, 1 month after and 6 months after the intervention	The Experience in Personal Social Systems Questionnaire assesses social aspects of quality of life (how the respondent feels about their own personal social system). Total score is created by adding all 12 items and the range is 12-72, higher scores indicating better social quality of life.
Change in Scores on the Patient Health Questionnaire Somatic Symptom Severity Scale (PHQ-15)	Before, 1 month after and 6 months after the intervention	The Patient Health Questionnaire Somatic Symptom Severity Scale includes 15 somatic symptoms (headache, stomach pain, chest pain, dizziness, etc.) that account for more than 90% of symptoms seen in primary care (exclusive of upper respiratory symptoms). Total score is the sum of all items, range is 0-30, higher scores indicate more somatic symptoms (worse physical health).
Change in Scores on the SCOFF Questionnaire	Before, 1 month after and 6 months after the intervention	The SCOFF Questionnaire is a brief screener to detect increased risk for eating disorders. The total score is created by summing all five items, leading to a score range of 0-5. Higher scores indicate higher eating disorder risk.
Change in Scores on ad Hoc Items to Assess Behavioral and Substance-related Addictions	Before, 1 month after and 6 months after the intervention	Items assess perceived problem severity with behavioral and substance-related addictions. The total scores is created by summing all four items resulting in a score range of 4-28. Higher scores indicate more severe behavioral and substance-related addiction severity.
Change in Scores on the Meaning in Life Questionnaire / Presence of Meaning Subscale	Before, 1 month after and 6 months after the intervention	The Presence of Meaning Subscale of the Meaning in Life Questionnaire assesses the perceived level of meaning in an individual's life. Total score is created by summing all 5 subscale items resulting a score range of 5-35. Higher scores indicate a higher sense of meaning in life (better mental health).
Change in Scores on the World Health Organization Wellbeing Index (WBI-5)	Before, 1 month after and 6 months after the intervention	The World Health Organization Wellbeing Index captures the general well-being of the individual. Total score is created by summing all 5 items, resulting in a score range of 0-15. Higher scores indicate better overall well-being.
Participant-perceived Iatrogenic Effects	1 month after and 6 months after the intervention	Qualitative responses on the perceived iatrogenic effects of the intervention were collected using-open ended, ad hoc questions.