This heading is called family work, not family therapy, and also not family support. Family work is not changing families, like was tried in the sixties, but it also different than just being nice to families. It means work for the clinician, the person who has (had) a psychosis and family members. When a family member is psychotic the other family members go through a process, often have to do difficult things. The clinician can discourage or encourage them. But it works. Family work is one of the most proven interventions in the care for psychosis.
Multi-Family Group Therapy
What is MFG?
Psychosis and multiple family group therapy, Eia Asen and Heiner Schuff. Asen has a somewhat different approach than Mc Farlane, mentioned below (les medical), but also a lot in common: shaping a community of people with the same problem.
Multifamilygroups in the Treatment of Severe Psychiatric Disorders McFarlane William R. - 2002 NY: Guilford Press, v This very clearly written book can be used as a manual for running Multi Family Groups.The unique advantage of MFT's is the phenomena of the forming of cross-relationships between parents and children who are vulnerable for psychosis from other parents and the other way around. McFarlane calls it changing from family relationships to neighbor relationships. More distance helps group members to use their wisdom, which surely isn't lacking. MFT is an evidence based practice.
Family Psychoeducation Evidence-Based Practices (EBP) KIT CD-ROM/DVD Version, available for free on Samsha
The evidence for family psychoeducation,
FPE is in fact the most evidence based psychological treatment for psychosis. But the evidence according to the very strict Cochrane rules is diminishing See Family intervention for schizophrenia Pharoah F, Mari JJ, Rathbone J, Wong W - 2010 Cochrane Database of Systematic Reviews The Cochrane institute has a rule that study must be blinded, which is almost not possible to accomplish. It is also working in the long term. In fact FPE has not very different results in the short term in family friendly institutes but it makes a difference after 5 years! See
Needs-based cognitive-behavioural family intervention for patients suffering from schizophrenia W. Sellwood, A. Wittkowski, N. Tarrier, C. Barrowclough - 2007 Wiley A 5-year follow-up of a randomized controlled effectiveness trial Acta Psychiatrica Scandinavica
Patients were less likely to relapse over the 5-year follow-up when they received the needs-based family intervention, especially in relation to exacerbations of symptoms not requiring inpatient admissions: 86.7% of control participants relapsed compared with 53.3% (P = 0.01). Survival analysis indicated that the relapse risk was 2.5 times higher for patients receiving routine care, compared with those receiving family intervention. A similar trend was observed for the final 4 years of follow-up. Comment Margreet. In this study family intervention was compared with a condition in which families were supported by an experienced family member.
The social and symptomatic course of early-onset schizophrenia. Five year follow-up of a psychosocial intervention. Like in Sellwood’s study: it seems that family support alone has a benevolent effect, while a therapeutic way of working has more effect on the long term. I know from Ria, that family members did not like the intervention, so the clinicians decided to stop this intervention, years after their decision it appeared that the intervention really worked!!!
Early intervention services, cognitive–behavioural therapy and family intervention in early psychosis: systematic review, V. Bird, P. Premkumar, T. Kendall, C. Whittington, J. Mitchell and E. Kuipers
Latest information from IEPA conference Dr Juliana Umniware: identifying moderators and predictors of treatment outcome in caregivers, an RCT, go to 43,28 minutes.
Forms of family work where the person who had a psychosos is the initiator
Resource Group Assertive Community Treatment (RACT)
This method was also founded by Falloon. The person who wants to recover chooses family members, friends, neighbours who wants to assit him to reach his goals.See also this artcle
Implementing specialist psychological support for caregivers in psychosis services: a preliminary report. This article in psychosis describes a method for supporting family members
Websites
Recovery for cares
Recommendations from the Meriden Institute. A comprehensive list of literature of the Meriden Institute. See page
Association for Multiple Family Group view-book
Books
Recommended Books and Articles on how to apply Family Psychoeducation
Expressed Emotion in families, its significance for mental illness. Leff, J. and Vaughn - 1985 Guilford New York
This is the classic book about the Expressed Emotion theory. The founders Brown, Leff and Vaughn explain the basic research on which this theory is based. The research is replicated all around the world. Today the EE concept is criticized, calling a parent high EE is stigmatizing too, while the intention of the founders was to destigmatize families. Clinicians who are familiar with working with families understand that angry and worried reactions of families are a result of the stress that unsupported families who live with a mentally ill member, experience.
Families as Partners in Mental Health Care: A Guidebook for Implementing Family Work. D. Froggatt, Fadden, G Johnson, D.L, Leggatt M. & Shankar R. - 2007 Toronto: World Fellowship for Schizophrenia An excellent guide for working with families from the famous British Meriden institute, based on the approach of Ian Falloon.
Family Work for Schizophrenia Leff, Julian, Lam, Dominique, and Elisabeth Kuipers - 2002-2004 The Royal College of Psychiatrists - This is a very practical manual for working with families. The authors belong to the founders of the method of the family psycheducation.
Advanced Family Work for Schizophrenia: An Evidence-Based Approach Julian P. Leff, Gaskell - 2005 Journal of Family Therapy From comprehensive records of about 150 families discussed during supervision, Julian Leff has distilled 19 anonymised case histories illustrating the most difficult problems encountered in such work. Each family is described in detail as presented by the supervisee. Then, the author gives his understanding of the problems in a social and cultural context, and makes recommendations for ongoing family work.
A Casebook of Family Interventions for Psychosis, Fiona Lobban, Christine Barrowclough - 2009 John Wiley and Sons A practical guide to implementing family interventions for psychosis, which discusses different family needs and illustrates different approaches to offering the interventions.
Bipolar Disorder: A Family-Focused Treatment Approach, David J. Miklowitz PhD, 2008 David Miklowitz worked with Michael Goldstein a pioneer in the family psychoeducation approach especially for first psychosis. In his opinion the strategy is somewhat different with persons with a bipolar disorder, it is more psychological.
