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Family Psychoeducation has been determined to be an efficacious, best practice, which assists to reduce relapse in Schizophrenia (Dixon & Lucksted, 2000).
Background: Beginning in the early 1950's there were many theories about schizophrenia that blamed the family for the schizophrenia (i.e., Fromm-Reichmann's 1948 "schizophrenogenic mother" theory). These family psychoeducational models that have developed over the last 20 years are not to blame the family or any perceived family "dysfunction" for this disorder. Instead, the family is rightfully seen as an alliance as the "stress-vulnerability" model has been favored (Bellack & Mueser, 1993; Dixon & Lucksted, 2000; Lehman et al., 1998b).
Historically, family interventions were applied only to families who were identified as having high levels of "expressed emotion", which means "criticism, hostility and overinvolvement" (Dixon & Lucksted 2000, pp.5). High expressed emotional families were targeted because it is known that people who are diagnosed with schizophrenia have difficulty deciphering criticism and overinvolved actions, and those people living in hostile environments. The PORT study presented an alternative recommendation: that all families who are involved in a person's treatment and recovery should be invited to family interventions.
Overall: This treatment modality creates a partnership of the person diagnosed with Schizophrenia, family members, treatment team, and supports, such as neighbors or friends. More than 30 Randomized Clinical Trials have demonstrated 1) Reduced relapse rates, 2) Improved recovery for patients and 3 Improved family well-being.
Schizophrenia Patient Outcomes Research Team (PORT) suggests all families be offered an educational intervention spanning at least nine months.
Why Family-Based Interventions?
· Schizophrenia is difficult for patients as well as their caregivers.
· Caregivers often provide emotional support, case management functions, financial assistance, advocacy and housing.
· This can be rewarding, but being a caregiver can be burdensome as well!
· Families need 1) Information, 2) clinical guidance, and 3) on-going support.
The basic principles are to:
- Master new ways of managing,
- enhance the family's coping skills, and
- to reduce tension in the family (Bellack & Mueser, 1993; Evidence-based practices, 2003 http://www.mentalhealth.org).
How to Implement an Effective Program:
- Are diagnosis specific (e.g., Schizophrenia)
- Effective Family Psychoeducation programs include:
- Empathetic engagement
- Education
- Ongoing support
- Clinical resources during periods of crisis
- Social network enhancement
- Problem-solving.
- Communication skills
Goals for Working with Families
- To achieve best outcome
- Alleviate suffering.
Universal characteristics of an evidence-based family psychoeducational program (Dixon & Lucksted, 2000):
- They work on the premise that schizophrenia is an illness,
- professionals facilitate the program,
- is one part of many other evidence-based treatments, such as the medications,
- family members are partners-not patients,
- patient and family outcomes are important,
- the family's communication patterns or behaviors are not to blame.
Psychoeducation is designed to include:
- Introductory sessions
- Educational workshops
- Problem-solving to help deal with problems
- Pay attention to clinical and social goals of client
- Families as equal partners
- Explore family members expectations
- Assess strengths and limitations
- Help resolve family conflict
- Address feelings of loss
- Provide relevant information
- Crisis planning
- Help to improve communication
- Training for families using problem-solving techniques
- Encourage expansion of familys social network
- Be flexible
- Provide referrals and easy access to professional care after treatment.
Research:
- Randomized Controlled Trials have demonstrated a 50% lower relapse rates after one year of being involved in family psychoeducation programs (in combination with medications) than those receiving medication alone. One study showed that the benefits of this intervention persisted for two years! (Lehman & Steinwachs, 2003).
- Studies have shown that the effective, ideal number of sessions range between four to nine months to many years (Bellack & Mueser, 1993; Dixon & Lucksted, 2000); this discrepancy is due to the family's need and the program goals.
- Family program effectiveness will be effected by participant's "phase of illness, family and patient life cycle stages, and cultural background" (Dixon & Lucksted, 2000, pp. 14).
- Barriers against this type of intervention includes 1) the mental illness stigma, the relationships between the caregiver and diagnosed person (e.g., is it a conflicted relationship? Will the person with schizophrenia provide the clinician with the family's contact information?), and possible inadequate staff training.
IS PSYCHOEDUCATION APPROPRIATE FOR MY FAMILY?
Questions quoted from Dixon & Lucksted, 2000 research.
- Are the family and patient interested in participating in family psychoeducation?
- To what extent is the patient involved with the family and what is the quality of the relationship?
- Are there clear patient-related outcomes that clinicians, family members, and patients can identify as goals, such as decreased relapse or increased employment?
- Would the patient and family choose family psychoeducation instead of alternatives available in the agency or community to achieve outcomes identified? (pp. 16)
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CONSIDER THIS:
MANY TIMES PERSONS WITH SCHIZOPHRENIA DEPEND UPON CLOSE SUPPORTS FOR EMOTIONAL, FINANCIAL, HOUSING AND ADVOCACY SUPPORT.
DOESN'T IT SEEM AS THOUGH THESE WELL RESEARCHED INTERVENTIONS --THAT IMPROVE THE QUALITY OF THE FAMILIAL RELATIONSHIP --ARE NECESSARY?
A sample psychoeducation program (Merinder et al. 1999):
1. Introduction
2. What is Schizophrenia? Diagnosis/prognosis/symptoms.
3. What causes Schizophrenia?
4. Medication: effect/side effects
5. Psychosocial Treatment
6. Stress and early signs of relapse: emergency plan
7. What can you and your family do about it?
8. Laws and regulations.
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