Skip to main content

Advertisement

Log in

How Professionals View Multifamily Psychoeducation: A Qualitative Study

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

Severe mental illness causes suffering for the patient as well as the patient’s immediate family. The Swedish National Board of Health and Welfare has recommended the implementation of multifamily psychoeducation in order to assist patient and family in the recovery process. The aim of this study was to determine how introducing multifamily psychoeducation in Sweden has been viewed by professionals. Semi-structured interviews were conducted with 11 service providers, who were involved in evaluating multifamily psychoeducation. Our main findings fell under the headings of defensive culture and unsuitable model. Resistance to introducing the new intervention was found on multiple levels. The model proposed was considered too rigid for both the target group and the organizations because it could not be adjusted to the needs of patients, families, or facilitators. Despite good evidence for the effectiveness of the intervention, there were difficulties introducing the multifamily psychoeducation model in clinical practice. The feasibility of an intervention needs to be evaluated before adopting it as a national guideline.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Ostman M, Hansson L, Andersson K: Family burden, participation in care and mental health–an 11-year comparison of the situation of relatives to compulsorily and voluntarily admitted patients. International Journal of Social Psychiatry 46:191–200, 2000.

    Article  CAS  PubMed  Google Scholar 

  2. Motlova L: Schizophrenia and family. Neuro Endocrinology Letters 28 (Suppl 1):147–159, 2007.

    PubMed  Google Scholar 

  3. Caqueo-Urizar A, Miranda-Castillo C, Lemos Giraldez S, Lee Maturana SL, Ramirez Perez M, Mascayano Tapia F: An updated review on burden on caregivers of schizophrenia patients. Psicothema 26:235–243, 2014.

    PubMed  Google Scholar 

  4. Noh S, Turner RJ: Living with psychiatric patients: implications for the mental health of family members. Social Science and Medicine 25:263–272, 1987.

    Article  CAS  PubMed  Google Scholar 

  5. Ostman M, Kjellin L: Stigma by association: psychological factors in relatives of people with mental illness. British Journal of Psychiatry 181:494–498, 2002.

    Article  PubMed  Google Scholar 

  6. Brown GW, Birley JL, Wing JK: Influence of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry 121:241–258, 1972.

    Article  CAS  PubMed  Google Scholar 

  7. Vaughn C, Leff J: The measurement of expressed emotion in the families of psychiatric patients. British Journal of Social and Clinical Psychology 15:157–165, 1976.

    Article  CAS  PubMed  Google Scholar 

  8. Falloon IR, Boyd JL, McGill CW, Razani J, Moss HB, Gilderman AM: Family management in the prevention of exacerbations of schizophrenia: a controlled study. New England Journal of Medicine 306:1437–1440, 1982.

    Article  CAS  PubMed  Google Scholar 

  9. Hogarty GE, Anderson CM, Reiss DJ, Kornblith SJ, Greenwald DP, Javna CD et al.: Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. I. One-year effects of a controlled study on relapse and expressed emotion. Archives of General Psychiatry 43:633–642, 1986.

    Article  CAS  PubMed  Google Scholar 

  10. Lehman AF, Steinwachs DM: Patterns of usual care for schizophrenia: initial results from the Schizophrenia Patient Outcomes Research Team (PORT) Client Survey. Schizophrenia Bulletin 24:11–20, 1998.

    Article  CAS  PubMed  Google Scholar 

  11. Pharoah FM, Rathbone J, Mari JJ, Streiner D: Family intervention for schizophrenia. Cochrane Database of Systematic Reviews 4:88, 2003.

    Google Scholar 

  12. Pharoah F, Mari J, Rathbone J, Wong W: Family intervention for schizophrenia. Cochrane Database of Systematic Reviews 12:CD000088, 2010.

    PubMed  Google Scholar 

  13. O’Brien MP, Zinberg JL, Ho L, Rudd A, Kopelowicz A, Daley M et al.: Family problem solving interactions and 6-month symptomatic and functional outcomes in youth at ultra-high risk for psychosis and with recent onset psychotic symptoms: A longitudinal study. Schizophrenia Research 107:198–205, 2009.

    Article  PubMed  Google Scholar 

  14. Kopelowicz A, Zarate R, Wallace CJ, Liberman RP, Lopez SR, Mintz J: The ability of multifamily groups to improve treatment adherence in Mexican Americans with schizophrenia. Archives of General Psychiatry 69:265–273, 2012.

    Article  PubMed  Google Scholar 

  15. Rossberg JI, Johannessen JO, Klungsoyr O, Opjordsmoen S, Evensen J, Fjell A et al.: Are multi family groups appropriate for patients with first episode psychosis? A 5-year naturalistic follow-up study. Acta Psychiatrica Scandinavica 122:384–394, 2010.

    Article  PubMed  Google Scholar 

  16. Bradley GM, Couchman GM, Perlesz A, Nguyen AT, Singh B, Riess C: Multiple-family group treatment for English- and Vietnamese-speaking families living with schizophrenia. Psychiatric Services 57:521–530, 2006.

    Article  PubMed  Google Scholar 

  17. Chien WT, Norman I, Thompson DR: A randomized controlled trial of a mutual support group for family caregivers of patients with schizophrenia. International Journal of Nursing Studies 41:637–649, 2004.

    Article  PubMed  Google Scholar 

  18. Cuijpers P: The effects of family interventions on relatives’ burden: A meta-analysis. Journal of Mental Health 8:275–285, 1999.

    Article  Google Scholar 

  19. Phanthunane P, Vos T, Whiteford H, Bertram M: Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia. Cost Effectiveness and Resource Allocation, 2011. doi:10.1186/1478-7547-9-6.

    PubMed  PubMed Central  Google Scholar 

  20. McFarlane WR: Multifamily Groups in the Treatment of Severe Psychiatric Disorders. New York, Guilford Press; 2002.

    Google Scholar 

  21. Dixon L, McFarlane WR, Lefley H, Lucksted A, Cohen M, Falloon I et al.: Evidence-based practices for services to families of people with psychiatric disabilities. Psychiatric Services 52:903–910, 2001.

    Article  CAS  PubMed  Google Scholar 

  22. World Schizophrenia Fellowship: Families as Partners in Care: A Document Developed to Launch a Strategy for the Implementation of Programs of Family Training, Education, and Support. Toronto, World Schizophrenia Fellowship, 1998.

    Google Scholar 

  23. Murray-Swank AB, Dixon L: Family psychoeducation as an evidence-based practice. CNS Spectrums. 9:905–912, 2004.

    PubMed  Google Scholar 

  24. Jewell TC, Downing D, McFarlane WR: Partnering with families: multiple family group psychoeducation for schizophrenia. Journal of Clinical Psychology. 65:868–878, 2009.

    Article  PubMed  Google Scholar 

  25. Rummel-Kluge C, Kissling W: Psychoeducation in schizophrenia: new developments and approaches in the field. Current Opinion in Psychiatry. 21:168–172, 2008.

    Article  PubMed  Google Scholar 

  26. Lucksted A, McFarlane W, Downing D, Dixon L: Recent developments in family psychoeducation as an evidence-based practice. Journal of Marital and Family 38:101–121, 2012.

    Article  Google Scholar 

  27. Pakenham KI, Dadds MR: Family care and schizophrenia: the effects of a supportive educational program on relatives’ personal and social adjustment. Australian and New Zealand Journal of Psychiatry 21:580–590, 1987.

    Article  CAS  PubMed  Google Scholar 

  28. Abramowitz IA, Coursey RD: Impact of an educational support group on family participants who take care of their schizophrenic relatives. Journal of Consulting and Clinical Psychology 57:232–236, 1989.

    Article  CAS  PubMed  Google Scholar 

  29. Birchwood M, Smith J: Expressed emotions and first episodes of schizophrenia. British Journal of Psychiatry 151:859–860, 1987.

    Article  CAS  PubMed  Google Scholar 

  30. Orhagen T, d’Elia G: The ‘diagnostic history’ of schizophrenia. A retrospective study of 84 Swedish inpatients. Psychopathology 25:41–48, 1992.

    Article  CAS  PubMed  Google Scholar 

  31. Gonzalez-Blanch C, Martin-Munoz V, Pardo-Garcia G, Martinez-Garcia O, Alvarez-Jimenez M, Rodriguez-Sanchez JM et al.: Effects of family psychoeducation on expressed emotion and burden of care in first-episode psychosis: A prospective observational study. The Spanish Journal of Psychology 13:389–395, 2010.

    Article  PubMed  Google Scholar 

  32. Harvey C, O’Hanlon B: Family psycho-education for people with schizophrenia and other psychotic disorders and their families. Australian and New Zealand Journal of Psychiatry 47:516–520, 2013.

    Article  PubMed  Google Scholar 

  33. Dixon L, Adams C, Lucksted A: Update on family psychoeducation for schizophrenia. Schizophrenia Bulletinl. 26:5–20, 2000.

    Article  CAS  PubMed  Google Scholar 

  34. Leff J: Family work for schizophrenia: Practical application. Acta Psychiatrica Scandinavica Supplementum 102(407):78–82, 2000.

    Article  Google Scholar 

  35. Berry K, Haddock G: The implementation of the NICE guidelines for schizophrenia: Barriers to the implementation of psychological interventions and recommendations for the future. Psychology and Psychotherapy: Theory, Research and Practice 81:419–436, 2008.

    Article  Google Scholar 

  36. Socialstyrelsen: Nationella riktlinjer för psykosociala insatser vid schizofreni eller schizofreniliknande tillstånd 112, 2011.

  37. Dixon LB, Dickerson F, Bellack AS, Bennett M, Dickinson D, Goldberg RW et al.: The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophrenia Bulletin 36:48–70, 2010.

    Article  PubMed  Google Scholar 

  38. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE et al.: Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. Journal of Clinical Epidemiology. 51:1171–1178, 1998.

    Article  CAS  PubMed  Google Scholar 

  39. Bjorkman T, Svensson B: Quality of life in people with severe mental illness. Reliability and validity of the Manchester Short Assessment of Quality of Life (MANSA). Nordic Journal of Psychiatry. 59:302–306, 2005.

    Article  PubMed  Google Scholar 

  40. Kjellberg A, Iwanowski S: Stress/energiformuläret: Utveckling av en metod för skattning av sinnesstämning i arbetet. [The Stress/arousal questionnaire: Development of a method for assessment of mood at work] Report no. 26, 1989.

  41. Carver CS: You want to measure coping but your protocol’s too long: Consider the brief COPE. International Journal of Behavioral Medicine 4:92–100, 1997.

    Article  CAS  PubMed  Google Scholar 

  42. Hjarthag F, Helldin L, Norlander T: Psychometric properties of the burden inventory for relatives of persons with psychotic disturbances. Psychological Reports 103:323–335, 2008.

    PubMed  Google Scholar 

  43. Levene JE, Lancee WJ, Seeman MV: The perceived family burden scale: Measurement and validation. Schizophrenia Research 22:151–157, 1996.

    Article  CAS  PubMed  Google Scholar 

  44. Lincoln YS, Guba EG: Naturalistic Inquiry. Beverly Hills, Sage, 1985.

    Google Scholar 

  45. Gold PB, Glynn SM, Mueser KT: Challenges to implementing and sustaining comprehensive mental health service programs. Evaluation and the Health Professions 29:195–218, 2006.

    Article  PubMed  Google Scholar 

  46. Lam DH, Kuipers L, Leff JP: Family work with patients suffering from schizophrenia: The impact of training on psychiatric nurses’ attitude and knowledge. Journal of Advanced Nursing 18:233–237, 1993.

    Article  CAS  PubMed  Google Scholar 

  47. Addington J, McCleery A, Addington D: Three-year outcome of family work in an early psychosis program. Schizophrenia Research 79:107–116, 2005.

    Article  PubMed  Google Scholar 

  48. Fjell A, Bloch Thorsen GR, Friis S, Johannessen JO, Larsen TK, Lie K et al.: Multifamily group treatment in a program for patients with first-episode psychosis: Experiences from the TIPS project. Psychiatric Services 58:171–173, 2007.

    Article  PubMed  Google Scholar 

  49. Glynn SM, Cohen AN, Dixon LB, Niv N: The potential impact of the recovery movement on family interventions for schizophrenia: Opportunities and obstacles. Schizophrenia Bulletin. 32:451–463, 2006.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Nilsen L, Frich JC, Friis S, Røssberg JI: Patients’ and family members’ experiences of a psychoeducational family intervention after a first episode psychosis: a qualitative study. Issues in Mental Health Nursing. 35:58–68, 2014.

    Article  PubMed  Google Scholar 

  51. Resnick S, Rosenheck R, Dixon L, Lehman A: Correlates of family contact with the mental health system: Allocation of a scarce resource. Mental Health Services Research 7:113–121, 2005.

    Article  PubMed  Google Scholar 

  52. Rummel-Kluge C, Pitschel-Walz G, Bäuml J, Kissling W: Psychoeducation in schizophrenia—results of a survey of all psychiatric institutions in Germany, Austria, and Switzerland. Schizophrenia Bulletin 32:765–775, 2006.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Proctor EK, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B: Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health 36:24–34, 2009.

    Article  PubMed  Google Scholar 

  54. Magliano L, Fiorillo A, Fadden G, Gair F, Economou M, Kallert T et al.: Effectiveness of a psychoeducational intervention for families of patients with schizophrenia: preliminary results of a study funded by the European Commission. World Psychiatry 4:45–49, 2005.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The authors affirm having received no grants from any funding agency in the public, private, or non-profit sector in conjunction with this paper.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to K. Ingvarsdotter.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human rights and informed consent

The study was approved by the Regional Ethics Board (EPN), Lund, Sweden. Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ingvarsdotter, K., Persson, K., Hjärthag, F. et al. How Professionals View Multifamily Psychoeducation: A Qualitative Study. Psychiatr Q 87, 479–491 (2016). https://doi.org/10.1007/s11126-015-9401-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-015-9401-3

Keywords

Navigation