Psychoeducation offers an empirically based form of intervention that seeks to educate distressed families so that they might develop skills for understanding and coping with disturbed families or troubled family relationships.
This approach to family therapy helps support and empower families with schizophrenic members, violent families, those where alcohol or substance abuse is uncontrolled, families struggling with chronic illness, or even those simply wishing to improve their relationship skills.
Unlike post modern and poststructural approaches, the Psychoeducational model relies on traditional, modernist experimental methods to develop verifiable intervention procedures.
It maintains a focus on stress management and skills-building techniques to help families gain a sense of control.
Psychoeducation utilizes many techniques of more traditional family therapy in their interventions; including establishing an alliance with its members, maintaining neutrality, and assessing how best to foster positive outcomes.
Interventions are intended to be ‘manual based’ – they are reproducible techniques that follow a how-to-do-it format that can be copied by all mental health workers without requiring high levels of training.
FAMILIES AND MENTAL DISORDERS
Mental illness in a daily can be a “ravaging, devastating disease” that disrupts a family and permits little opportunity for respite. In addition to the social stigma and ostracism of people with mental illness, families with mentally ill members also confront household disarray, financial difficulties, employment problems, strained marital and family relationships, impaired physical health, and a diminished social life. Psychoeducation teaches anguish family members how and from whom in the community to obtain mental health, welfare, and medical services, or legal services.
Working with Families and Severe Mental Illness
Schizophrenia is a thought disorder in a biologically vulnerable person. It is viewed as a genetic and/or biologically based disease whose symptoms are best dealt with by using antipsychotic medication. Psychoeducational family therapy is now seen as a mandatory component (along with psychopharmacology) of the state of the art treatment of the major psychoses.
Environmental factors within family life do play a role in schizophrenic ‘relapse rates’. Psychoeducation advocates maintain that helping family members gain knowledge of the disorder and learn specific coping skills is essential in supplanting medication.
Relapse in schizophrenic, bipolar, or substance abuse patients occurs often when patients are returned back to their families. To prevent this relapse:
- Traditional family therapy and having a focus on the disorder of the illness on the family.
- Instead of being held accountable, families were recognized as having experienced great stress.
- Instead of exploring and uncovering damaging interactive patterns, families were now given support as they learned new empowering techniques to mitigate stress and reduce likelihood of stress.
Psychoeducational focus is on the patient’s impact on family functioning. It is highly structured. Goals include: being a part of a community based care program and the education of patients and their families regarding the disorder.
Also incorporated are “survival skills workshops” – addressed to assigning chores to patient, setting limits, reducing unrealistic expectations.
The Therapeutic Process
Family psychoeducation efforts follow one of two formats:
1) Working with individual families
- Utilize a set of phased interventions (often resembling structural family therapy), beginning with engaging the family, typically when an acute schizophrenic decomposition has occurred. Patient and family needs are discussed, and family coping skills are strategized.
- Achievements are aimed at stabilizing outside of the hospital. Patients are assigned small tasks and their progress monitored.
2) Working with multiple families simultaneously
- Provides social support for families to solve ward management problems who otherwise would have felt isolated.
- Lecture and discussion workshops are held with relatives.
MEDICAL FAMILY THERAPY
Medical Family Therapy is a form of psychoeducational family therapy involving collaboration with physicians and other health care professionals in the treatment of persons or families with health problems. The aim here is to cope better with a chronic illness, engage in less conflict over managing medication, communicate better with medical providers, accept a medical problem that cannot be cured, and perhaps make constructive lifestyle changes. Advocates of this view believe that the family serves as the primary social context for healthcare and, correspondingly, what goes on within the family inevitably influences a family member’s medical condition.
Psychosocial Factors and Individual Health
No biomedical event occurs without psychosocial consequences. The goodness of “fit” between psychosocial demands of the disorder (cancer, diabetes, heart disease, AIDS) and the family’s customary style of functioning and their resources become the major determinant of how successfully they cope and adapt as a family. Also, if family’s belief system is discrepant with the belief system of the health providers, they may reject treatment or not comply with medical/psychological recommendations and prescriptions.
Collaborative Family Healthcare Association
Collaborative Family Healthcare Coalition: This association serves as a communication network, a clearinghouse disseminating information with the purpose of promoting a more coordinated, family-centered model of healthcare delivery integrating traditional medical/nursing care, psychosocial services, and the services of related healthcare providers.
Each phase of an illness poses its own psychosocial demands and developmental tasks, calling for significantly different strengths, attitudes, or changes from the family; Onset (of diagnosis), Course, Outcome, Incapacitation
Family Therapist-Physician Partnerships
Medical family therapists need a working knowledge of the major chronic illnesses and disabilities, as well as their emotional sequelae, along with familiarity with the healthcare system.
- Physician – able to educate the therapist about the causes, likely course, and prognosis of a disease (biology)
- Therapist – (acting as a consultant or co-therapist) can enlighten the physician and other caregivers about the patient’s experience of illness, perhaps by exploring how to minimize anxiety. (psychosocial)
Family Therapist-Family Partnerships
One goal of a successful therapist-physician collaboration is to strengthen the shaken family system, allowing its member to regain a sense of choice and power about impending medical decisions. Dealing with serious illnesses on a daily basis is often a lonely and stressful task for the therapist. Sharing the responsibility (and its satisfactions) with other professionals and with the family is often crucial in avoiding burnout.
SHORT TERM EDUCATIONAL PROGRAMS
The psychoeducational approach has also been extended to couples or families without a symptomatic member who wish to acquire better skills or learn specific strategies for coping more effectively with their everyday relationship problems (martial conflicts, parent-adolescent conflicts).
Generally it is brief, practical, positive in tone and outlook, and cost-effective. Programs involving relationship enchantment, preparation for marriage or childbirth, marriage enrichment, and parent effectiveness training are all examples of these psychoeducational efforts along with the behavioral parent skills training procedures as with the CBT model. The therapist’s goal is to deliver educational training and not psychotherapy. Termination usually occurs when the content has been delivered or when a previously agreed-upon time frame has been completed.
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