Working with Families

1. Working with Families

2. Linda May, PhD, MFT – Case Manager, PART

3. The experience of working with families • What would you want if you or a loved one developed a high risk or psychotic illness? • What would you expect would be the stressors, skill deficits, AND Areas of strength

4. Systems - homeostasis

5. Organizational Homeostasis

7. Genogram

8. Family therapy – then and now • Dysfunctionality based approaches • Best possible outcome for consumer and family thru collaboration • Evidence-based family intervention

9. Functional & Problem Behaviors

10. Family work in prodrome, and early psychosis • Research supports need for comprehensive txt – meds, family wk, milieu/occupational, & psychosocial • Earlier treatment improves prognosis • Support and education of individual and family • Family may be main caregiver

11. Ultra High Risk & Psychosis in Developmental Perspective • Normal development individuation, formal operations, identify formation, family system temperaments, significant life events • Ultra High Risk & Psychotic symptoms – impact on communication, expectations

13. Family as support vs. stressor • Family style (EE research) pre, post symptoms • Stigma impact • Lack of comprehensive support network • “Warm, positive” versus “critical, overprotective”

14. Components of expressed emotion: Prodromal vs. chronic phase SAS-III, Rejection and Emotional Over-involvement subscales All differences, prodromal vs. chronic: p<0.01

15. Effects of EE and contact on relapse in schizophrenia Bebbington and Kuipers, 1994

16. Family Guidelines • System changes, sib realignment, need for family support • Grief, loss regarding “former child” • Impact on parental identification • Impact on “launching” plans • Impact on child’s individuation, identity with adolescent, young adult peers

17. Social networks in schizophrenia • Family network size • diminishes with length of illness • decreases in the period immediately following a first episode • is smaller at the time of first admission • Networks • buffer stress and adverse events • determine treatment compliance • predict relapse rate • correlate with coping skills and burden.

18. Key family interventions specific to prodromal psychosis • Strengthening relationships and creating an optimal, protective home environment • Preventing onset of negativity and criticism • Reducing intensity, anxiety and over involvement • Adjusting expectations and performance demands • Minimizing internal family stressors as marital stress, sibling conflict/concerns, conceptual and attributional confusions and disagreement

19. References • Family Guidelines – Sources: Carol Anderson, Schizophrenia and the Family (Guilford Press, 1986); Dr. William McFarlane, Multi-Family Groups in the Treatment of Severe Psychiatric Disorders (Guilford Press, September 2004). • Concepts & Recommendations for clinicians Who Teach Families How to Manage Schizophrenia by Carole M. Anderson, Douglas J. Reiss, William R. McFarlane, MD • Family Expressed Emotion Prior to Onset of Psychosis – William R. McFarlane, MD, William L. Cook, PhD • Family Psychoeducation and Schizophrenia: A Review of the Literature – William R. McFarlane, Lisa Dixon, Ellen Lukens, Alicia Lucksted • Multifamily Groups in the Treatment of Severe Psychiatric Disorders by William R. McFarlane