Family Therapy in Developing Countries Primary Care

Abstract

Purpose: Mental health and psychosomatic problems are both widespread and disabling in low and middle-income countries (LMIC). There is a clear need for strategies to strengthen first line services for their treatment. Family ('systemic') therapy has been shown to be effective in this setting but there is a dearth of research investigating its use. Methods: A family therapist, psychiatrist by training was interviewed by a public health doctor specialized in health services organization, to derive concepts useful for GPs and nurses working in LMIC first line services to handle the relational and emotional component of bio-psychosocial care. The interview was supplemented with a literature review. Results: Concepts in systemic therapy conditions dealt with by systemic therapy are detailed together with basic concepts in systemic approach e.g. symptom persons, family homeostasis, neurotic vs. psychotic families, therapeutic resources, circular questioning, reframing, paradoxical injunctions, therapy steps, strategies to accompany changes, and required organization features. Conclusions: First line professionals can be involved in the treatment of psychic and relational disorders without in-depth preparation. Family/systemic therapy appears more effective than psychoanalytical techniques in LMIC because there is limited tradition of introspection in LMIC, and families in LMIC remain strongly structured and a key social safety net. Systemic therapies can have an important impact on quality of care where health professionals have no tradition of properly handling bio-psychosocial disorders and improve doctor-patient communication. However, more experience is needed to define the conditions for its optimal utilization in LMIC.