Family Work for Schizophrenia: A Practical Guide
| Manual Title |
Family Work for Schizophrenia: A Practical Guide |
| Creators |
Elizabeth Kuipers, Ph.D., Julian Leff, M.D. and Dominic Lam, Ph.D. |
| Reference |
Kuipers, E., Leff, J. & Lam, D. (2002). Family work for schizophrenia: A practical guide. 2nd ed. London: Gaskell Press. |
| Price |
~$25.00 |
| Contact Information: |
Elizabeth Kuipers, PhD.
Professor of Clinical Psychology
PO77, Department of Psychology
Institute of Psychiatry, De Crespigny Park
London SE5 8AF
Phone: +44(0)20 7848 0414
Email:E.Kuipers@iop.kcl.ac.uk
|
Program Overview:
Theoretical Approach:
Combination of supportive approach, psychoeducation & "family approach"
Treatment is based on predictive power of EE
Treatment Assumptions:
- Schizophrenia has a biological origin (diathesis stress model)
- Caregivers are therapeutic agents
- Emphasis on openness & partnership with families
- Family is seen to have needs & strengths
- Psychosocial family intervention is part of a larger treatment plan (medications, etc)
Format:
Treatment program has several phases:
- Education: 2 sessions for relatives only in patient's home, using booklet (symptoms, course, causes & treatment of schizophrenia)
- Individual family sessions in patient's home (& including the patient) every 2 weeks for 6-9 months, then once/month (range from 9 month-3 year total
treatment duration) Note: book chapters include general comments & brief clinical vignettes on communication skills, goal setting, coping with negative emotions, etc.
Note: Kuipers et al's original writing on this approach described the relatives' group as the third phase of the intervention. However, due to the high drop out rate in some groups (e.g., Pilling et al.,
2002), the 2nd edition of her book (2002) focuses more on single-family interventions and describes relatives groups as an alternate format.
- Relatives' group: 2 therapists with 10-12 relatives in a group (patients are NOT included). Meetings last 90 minutes, and families attend every 2 weeks at the beginning (and move to once/month later). Groups are open-ended, and families usually participate for 9 months.
- Group goals:
- Lower criticism & over-involvement
- Help relatives share experiences & process upsetting emotions
- Allow relatives to problem-solving together
- Increase relatives social support to decreased stigma/isolation
- Group structure:
- Each person does check-in
- Discussion of theme that arose (common issues include: medications, causes of symptoms, employment, benefits issues, practical problems, stigma, feelings of isolation, grief/loss, anger, helpless, fear, accessing mental health system for treatment)
Note: Book includes Helpful Aspects of Therapy (HAT) form that family members complete after each session (what was most helpful & why; what may have been helpful?)
Note: According to the above text, the treatment also includes videos and a Training Manual for Therapists (available from authors)
Research:
Leff et al (1985):
- Methods:
Random assignment to family treatment or routine treatment
Family treatment involved: a short education program, individual family sessions in the home, and a relatives group had
- Results
After 2 years:
- 14% relapse in family treatment group vs
- 78% relapse for routine treatment
Leff et al (1990):
- Methods: Subjects were patients who had high EE relatives
All families had 2 educational sessions in the home. Then random assignment to either:
- 60 min FAMILY treatment in home every 2 weeks including patients (median of 17 sessions in 9 months)
- 90 min relative's group excluding patient (every 2 weeks for at least 9 months)
- Results
After 2 years:
- In home family treatment: relapse rate of 33%
- Relative's group: relapse rate of 36%
- Patients whose families were offered no help had 75% relapse rate)
- Leff et al's conclusion: The relatives' group is the treatment mode of choice (but obviously some families will not attend)
Note: Above description reviewed and approved by Dr. Kuipers, 11-25-02
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