July 17, 2007

Family-Focused Therapy with Schizophrenia

Many family therapy pioneers began their work with patient's suffering from schizophrenia. Murray Bowen, possibly one of the most well known frontiers of family therapy began his work with schizophrenic patients. During his time, he actually began hospitalizing entire families so that the "system" could be treated. This was highly innovative therapy, yet much too extreme. Those drastic measures of the Bowen days have paved the way for a newer approach to family therapy with severe mental illness, which some refer to as family-focused therapy. The Wall Street Journal included an interesting piece on how this approach is being used with a wide range of disorders, and the potential benefits, and possible risks. Its currently becoming a go to treatment for those with bipolar disorder and similarly can help families with those suffering from schizophrenia.

This new trend in family therapy focuses on treated the identified patient, the one suffering form the severe mental illness (commonly schizophrenia, bipolar disorder, anorexia, or other disorders where insight may be impaired). But it’s different from individual therapy because it incorporates family members. Its similar to family pscyhoeducation, in that it helps family members understand and cope with caretaking, but its also allows the family members to help treat the identified patient.

Family-based counselors meet regularly with the patient and family members. Certain loved ones, most often a spouse or parents, but sometimes siblings, as well, are designated as caregivers. Each member of the family, including the patient, agrees to the open nature of the treatment -- sometimes signing a waiver outlining what information the therapist can share with relatives. This can include details about symptoms and medication.

Family members are free to talk to the therapist about their loved one's behavior, symptoms and progress (as per agreed upon in the informed consent). They also talk about how their relative's illness affects them. The aim is to give each family member support and a role in the treatment.

Critics of family-based therapy say that the lack of boundaries can be dangerous. Patients may be leery of sharing intimate information with a therapist because they know there is a lower bar on confidentiality. And family members may resist talking about their problems.

But these issues with boundaries are lessened when working with a therapist who is open to restructuring some parts of the therapy process, in order to meet the needs and desires of the particular family. Informed Consent, which is very important in every kind of therapy but tenfold in family-based interventions, is the document that outlines the therapy, the risks, the rights of all clients, as well as the legality of therapy. When more than one person is the client, as is the case with a family, information about disclosure, and confidentiality need to be made very clear. Family members need to be aware and agree upon the terms so that there are no surprises or "secrets". Informed consent is treated as a contract, and is often signed by all members of the therapy process (therapist and clients).

Family-Based approaches also are similar to CBT, in that they are time limited, focus on the "here and now", as well as symptoms relief and symptom management.

Rather than going on indefinitely, the therapy is prescribed for a limited time, typically nine months to a year, with the idea that families will gain skills to continue on their own.

"What has happened in the past is mental-health professionals and the public would blame families and criticize them," says Susan Gingerich, a social worker in Philadelphia who uses family-based therapy to treat people with schizophrenia and has written many books on treating schizophrenia. "In fact, they can be an important source of treatment."

This type of therapy is especially useful with patients who may lack insight into their own illness (schizophrenia and bipolar disorder), or not be able to coherently relay their recent behaviors. Family members hold a huge wealth of information about the client’s behaviors, their moods, and the stability of these things. When it’s a psychotic illness, perception of reality is impaired, so family members who often live with or near the client can help piece together what’s been going on.

Family interventions have been shown to decrease relapse rates and reduce the need for hospitalization. These approaches also help with medication management, and help build trust with family, providing for a safe support network. Most psychotherapists would agree that apart from drug treatment and CBT, family-focused interventions are the most beneficial form of therapy for individuals with schizophrenia. Younger patients with schizophrenia who may still live with parents might benefit the most from family-focused approaches, but for all age groups, whenever possible, family-focused therapy can be helpful.

Read Full Article:
Letting Your Family In on Your Therapy Approach Enlists Loved Ones To Participate in Treatments; Overcoming the Privacy Issue. Wall Street Journal Online.

Research-based Family Interventions for the Treatment of Schizophrenia
Susan L. Gingerich, M.S.W. and Alan S. Bellack, Ph.D.

Family psychoeducation and schizophrenia: A review of the literature
Journal of Marital and Family Therapy, Apr 2003 by McFarlane, William R, Dixon, Lisa, Lukens, Ellen, Lucksted, Alicia

Family Education Programs

Family and Cognitive Interventions for Schizophrenia

Book on Family Psychoeducation


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