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Family Psychoeducational Approach

Several studies have shown that family psychoeducational interventions can lead to a change in the level of criticism and over-involvement among relatives of people with schizo­phrenia and a reduction in the relapse rate. The bene­fits of a low-stress house­hold on the relapse rate in schizo­phrenia appear to be equally as strong as the effect of antipsy­chotic drug treat­ment. Someone with schizophrenia who is taking antipsychotic medication and living in a high EE household runs a roughly 50 percent chance of relapse in the course of a year; if the household can be changed to a low EE environment, the relapse rate drops to 10 percent or less. Effective interventions provide three basic ingredients: (1) detailed information about the illness for the family and pa­tient; (2) help for the family to develop problem-solving mecha­nisms; and (3) practical and emotional support.

In the intervention designed by Leff and Vaughn in Britain the family is given education, usually in the family home, on the diagnosis, causes, course, and management of schizophrenia. The family is also invited to join a relatives’ group in which high EE relatives can learn directly from low EE family members about how one can cope with the day-to-day problems of living with someone with schizophrenia without becoming excessively critical or over-involved. The family member with schizophrenia is not invited to attend the relative’s group.

The psychoeducational method developed by Falloon consists of education about schizophrenia, communication training, a structured problem-solving method, and other behavioral strategies. The educational material includes information about medication, side effects, warning signals of impending relapse and the risks of street drug use. The communication training looks at the expression of positive and negative feelings in the family, listening skills, and how to ask others for changes in behavior.

 

McFarlane has developed a multiple family group approach which aims to reduce feelings of blame and perplexity, and provides avenues for changing family interaction patterns while providing support and education.

These family psychoeducational approaches have all proven highly effective in reducing the rate of relapse in schizophrenia. A meta-analysis of the available randomized controlled trials published in 1994 found that, for every two to five patients treated, one episode of relapse is prevented. The approach, however, has not disseminated at all broadly in community psychiatric practice anywhere in the world. Only seven per cent or fewer people with schizophrenia in the US, for example, get involved in a family intervention program. There are a number of explanations for this. In many areas, few people with schizophrenia live with family. In addition, organized attempts to disseminate the model to mental health managers and providers have been almost nonexistent because, unlike psycho-pharmaceutical products, no-one stands to make a profit from marketing the approach, and those who could benefit most, organizations of families of people with serious mental illness, have often considered any form of family intervention to be stigmatizing and have not lobbied for dissemination of the model.

Most of the work cited above was published in the 1980s or early 1990s, and little development of the model has occurred in the past fifteen years. However, the advent of the internet has opened the door to new possibilities for disseminating the model. Recent publications describe a web-based psychoeducational intervention for people with schizophrenia and their families. Three secure internet forums were created for this intervention – one for family-members only, one for consumers only, and one for both groups of users. Each forum is led and moderated by a trained therapist/facilitator. A library of educational resources and responses to previously answered questions is also provided online. A randomized controlled trial of the approach led to a large reduction in positive symptoms in the consumers and a growth in knowledge about schizophrenia in both patients and family members. Online delivery of family psychoeducation may have a promising future.