Advertisement

Psychological Treatments: The Family

  • Oliver Freudenreich
Chapter
Part of the Current Clinical Psychiatry book series (CCPSY)

Abstract

Taking care of a patient with schizophrenia is best done with the help of the patient’s family. Families are a resource, but they may need support and guidance in order to be most effective. This chapter provides practical advice on how to work with families, including how to recognize when a family needs more help and how to modify a stressful family environment, without assigning blame. The stress-diathesis model usefully explains to families how the interaction between genetic- and disease-related weaknesses and stress can cause symptoms in their relative. According to the expressed emotion model, reducing critical comments may reduce relapse risks for those patients who get stressed easily in social interactions, including family interactions. Included in this chapter is a section on a new model of care (“Open Dialogue”) that engages and enlists in help the patient’s larger social network.

Keywords

Family psychoeducation NAMI Family-to-family program Expressed emotions (EE) Stress-diathesis model Open dialogue 

References

  1. 1.
    Wikiquote: George S. Patton. Available from https://en.wikiquote.org/wiki/George_S._Patton. Accessed on 7/1/2019.
  2. 2.
    Jones K. Addressing the needs of carers during early psychosis. Early Interv Psychiatry. 2009;3:S22–6.CrossRefGoogle Scholar
  3. 3.
    Miller FE. Grief therapy for relatives of persons with serious mental illness. Psychiatr Serv. 1996;47:633–7.CrossRefGoogle Scholar
  4. 4.
    Kanter J. Engaging significant others: the Tom Sawyer approach to case management. Psychiatr Serv. 1996;47:799–801.CrossRefGoogle Scholar
  5. 5.
    Mueser KT, Penn DL, Addington J, Brunette MF, Gingerich S, Glynn SM, et al. The NAVIGATE program for first-episode psychosis: rationale, overview, and description of psychosocial components. Psychiatr Serv. 2015;66:680–90.CrossRefGoogle Scholar
  6. 6.
    Leff J. Working with the families of schizophrenic patients. Br J Psychiatry Suppl. 1994;164:71–6.CrossRefGoogle Scholar
  7. 7.
    Nuechterlein KH, Dawson ME. A heuristic vulnerability/stress model of schizophrenic episodes. Schizophr Bull. 1984;10:300–12.CrossRefGoogle Scholar
  8. 8.
    Dixon L, Lucksted A, Stewart B, Burland J, Brown CH, Postrado L, et al. Outcomes of the peer-taught 12-week family-to-family education program for severe mental illness. Acta Psychiatr Scand. 2004;109:207–15.CrossRefGoogle Scholar
  9. 9.
    Mercado M, Fuss AA, Sawano N, Gensemer A, Brennan W, McManus K, et al. Generalizability of the NAMI family-to-family education program: evidence from an efficacy study. Psychiatr Serv. 2016;67:591–3.CrossRefGoogle Scholar
  10. 10.
    Farrelly S, Brown G, Rose D, Doherty E, Henderson RC, Birchwood M, et al. What service users with psychotic disorders want in a mental health crisis or relapse: thematic analysis of joint crisis plans. Soc Psychiatry Psychiatr Epidemiol. 2014;49:1609–17.CrossRefGoogle Scholar
  11. 11.
    Foronda C, Baptiste DL, Reinholdt MM, Ousman K. Cultural humility: a concept analysis. J Transcult Nurs. 2061;27:210–07.CrossRefGoogle Scholar
  12. 12.
    Heru AM. Family psychiatry: from research to practice. Am J Psychiatry. 2006;163:962–8.CrossRefGoogle Scholar
  13. 13.
    Watters E. The shifting mask of schizophrenia in Zanzibar. In: Crazy like us: the globalization of the American psyche. New York: Free Press; 2011.Google Scholar
  14. 14.
    Seikkula J, Alakare B, Aaltonen J. Open dialogue in first-episode psychosis I: an introduction and case illustration. J Constr Psychol. 2001;14:247–66.Google Scholar
  15. 15.
    Gordon C, Gidugu V, Rogers ES, DeRonck J, Ziedonis D. Adapting open dialogue for early-onset psychosis into the U.S. health care environment: a feasibility study. Psychiatr Serv. 2016;67:1166–8.CrossRefGoogle Scholar

Additional Resources

    Websites

    1. https://www.nami.org – The website of the National Alliance on Mental Illness (NAMI) which has chapters in all 50 states. The group started around a kitchen table in 1979 as a grass-roots movement of several families who cared for somebody with serious mental illness. NAMI is primarily a resource for family members (education and support) and advocacy. As part of your treatment plan, refer families to their local NAMI chapter.

    Books

    1. Amador XF. I’m not sick, I don’t need help. 10th ed. Peconic: Vida Press; 2010. – The first book (first published in 2000) that tried to provide guidance about how to tackle the vexing issue of treatment refusal as a result of impaired insight (Amador suggested the anosognosia analogy for lack of insight in schizophrenia).Google Scholar
    2. Karp DA. The burden of sympathy: how families cope with mental illness. New York: Oxford University Press; 2001. – A sociologist brings to life the vicissitudes of caring for a mentally ill family member in postmodern America. A required reading for families and psychiatrists.Google Scholar
    3. Komrad MS. You need help!: A step-by-step plan to convince a loved one to get counseling. Center City: Hazelden Foundation; 2012. – Another book that provides pragmatic advice about how to engage and nudge help-rejecting patients towards psychiatric treatment.Google Scholar
    4. Mueser KT, Gingerich S. The complete family guide to schizophrenia: helping your loved one get the most out of life. New York: The Guilford Press; 2006. – An eminently practical guide for families about how best to help their relative with schizophrenia. While dated, its basic ideas remain valid.Google Scholar
    5. Torrey EF. Surviving schizophrenia: a family manual. 7th ed. New York: Harper Perennial; 2019. – The standard guide for families (and patients) by one of the outspoken and engaged leaders in public psychiatry; now in its 7th edition which speaks for itself.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Oliver Freudenreich
    • 1
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA

Personalised recommendations