Family Psychoeducation Therapies

Family Psychoeducation Therapies

The earliest approaches to family therapy were built upon indi-vidual psychotherapy and simply extended to the family their ideas about diagnosing and treating psychopathology, referring to “family pathology” instead of psychopathology. Early versions of psychodynamic, structural, strategic and cognitive–behavioral family therapies each assessed underlying family pathology and engaged families in corrective treatments. By the 1990s, however, family therapies were shifting to more collaborative therapeutic relationships in which families were regarded as allies, rather than sources of pathology, with education, rather than treatment, as the central focus.

This shift brought a sea change in how family therapy began to be practiced. Instead of diagnostic scrutiny, clinicians became preoccupied with learning to convey respect to families, to protect them from stigma, and to learn from their real-life ex-periences coping with illness. A focus on “looking at” families diagnostically in order “to intervene” in the family system, was gradually eclipsed by a commitment to “looking with” families as they coped with illness in order “to collaborate” with them in countering effects of illness on the family.

By the 1980s, some family therapists working with schzio-phrenia were proposing that family therapy could be more ef-fectively applied by engaging families as partners in treatment, instead as sources of psychopathology. These efforts were char-acterized by a fresh set of assumptions (Dixon and Lehman, 1995):

·              Severe psychiatric disorders, such as schizophrenia and bipo-lar disorder, are regarded as illnesses.

·              The family environment does not cause the disorder but can influence its course and severity.

·              Support is provided to families who are enlisted as partners and collaborators in treatment.

·              Family interventions are only one component in a treatment program that includes routine drug treatment and outpatient clinical management.

These new clinical approaches mixed psychoeducation, behavioral problem-solving training, family support and crisis management in interventions with either individual families or groups of families.

As a research contribution, the construct of expressed emotion (EE) played a significant role in the evolution of family psychoeducation (Leff and Vaughn, 1985). During a structured interview, families were given an EE rating based on observa-tions of critical comments, hostility and overinvolvement. Over two decades an enormous body of research suggested that patients living with families characterized by high levels of EE were more vulnerable to relapse (Anderson et al., 1986). Interventions were then designed that relied heavily upon family psychoeducation in order to enable high EE families to change to a low EE status.

Elements that appeared to be tied to its outcome effective-ness include:

·              Creation of social contacts and support;

·              Problem-solving with others bearing the burden of the same disorder;

·              Countering stigma;

·              Cross-parenting of adolescents;

·              Normalizing family communications;

·              Intervening effectively during crises.

Family-focused psychoeducational interventions also have been developed for other psychiatric disorders. Family-focused treatment for bipolar disorder, for example, integrates family psychoeducation, communication training and problem-solving into a 20-session therapy extending over most of a year. This intervention in a controlled study has been shown to delay relapse of bipolar disorder (Miklowitz and Goldstein, 1997; Miklowitz et al., 2000).